Chinese Journal of Tissue Engineering Research ›› 2017, Vol. 21 ›› Issue (11): 1707-1711.doi: 10.3969/j.issn.2095-4344.2017.11.012
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Qu Wei1, Huang Yun-fei1, Song Zong-rang1, Wu Qi-ning1, Wang Yu-fei2
Revised:
2017-01-21
Online:
2017-04-18
Published:
2017-05-06
Contact:
Wang Yu-fei, Master, Attending physician, Department of Orthopedics, Honghui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an 710054, Shaanxi Province, China
About author:
Qu Wei, Master, Attending physician, Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an 710054, Shaanxi Province, China
Supported by:
the National Natural Science Foundation of China, No. 81301604
CLC Number:
Qu Wei, Huang Yun-fei, Song Zong-rang, Wu Qi-ning, Wang Yu-fei. Bone graft to repair isthmus defect plus temporary single segmental screw rod fixation for adolescent lumbar spondylolysis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(11): 1707-1711.
2.1 参与者数量分析 纳入患者32例,按意向性处理,患者均完成13个月随访,全部进入结果分析。 2.2 患者手术时间、复位率、愈合时间 患者平均手术时间95 min(75-122 min),平均出血123.3 mL(70-200 mL)。Ⅰ度滑脱患者复位率92%(11/12),双侧峡部平均愈合时间(7.4±2.2)个月(5-13)个月。 2.3 患者腰痛目测类比评分、Oswestry功能障碍指数评分、椎间盘Pfirrmann分级及腰椎功能MacNab评价结果 腰痛目测类比评分由内固定前5.6±1.4降低到内固定后(峡部愈合)1.3±1.0,Oswestry功能障碍指数由内固定前(65.3± 15.7)%降低到内固定后(峡部愈合)(10.5±3.2)%。所有患者腰痛明显改善,没有无效及腰痛加重患者(表1)。术前相临上位椎间盘Pfirrmann分级A级11裂,B级21例,峡部愈合取出内固定后行MRI检查示固定节段上位椎间盘Pfirrmann分级与内固定术前无明显变化,全部患者相临上位椎间盘无退变产生。取出内固定后发现患者固定节段关节活动度保留。腰椎功能MacNab评价结果:优:27例,良:5例。"
2.4 不良反应 所有患者术中无血管神经损伤及脑脊液漏发生。所有患者无明显感染出现。所有32例患者未见内固定松动、断裂及峡部不愈合。 2.5 典型病例介绍 男性患者,28岁,职员,L5椎体双侧峡部断裂,无明显滑脱,患者诉无明显诱因出现腰痛2年, 进行性加重,不能参与正常工作生活,给与停止一切体育活动,全时段穿戴腰背支具6个月,腰痛无明显改善,CT示双侧L5峡部无明显愈合,给与峡部封闭治疗后,腰痛症状缓解,遂采用手术治疗,给与患者L5峡部修补+L5-S1节段临时固定,患者于术后7月双侧峡部骨性愈合。腰痛VAS评分由术前6分改善到峡部愈合时1分。Oswestry功能障碍指数评分由术前66.0%到术后4.0%。MRI检查示临近椎间盘信号较术前无明显改变,L5-S1活动度保留,患者目前已经参与正常工作学习并且没有腰痛及滑脱出现。见图1。"
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