目的 探讨峡部植骨+短期钉棒固定治疗腰椎峡部裂患者的临床效果。方法 针对2010-01至2022-12在武警广西总队医院脊柱外科接受治疗的173例腰椎峡部裂患者临床资料进行回顾性分析,按照患者的治疗方法划分为对照组(峡部植骨+U形钛棒固定,n=55)与研究组(峡部植骨+短期钉棒固定,n=118),比较手术完成情况、疼痛与腰椎功能、腰椎间盘退变情况以及峡部骨性愈合情况。结果 两组患者性别、年龄、手术时间、术中出血量比较无统计学差异。研究组峡部愈合时间[(10.65±0.68)月]短于对照组[(13.40±1.16)月],研究组住院时间[(14.43±2.32)d]短于对照组[(16.51±2.81)d],差异有统计学意义(P＜0.05)。手术后两组VAS、ODI评分均显著降低,但两组差异无统计意义。研究组峡部不愈合率为6.78%,低于对照组的20.34%,差异有统计学意义(χ²=8.298,P＜0.05)。研究组临近椎间盘退变率为2.54%,虽低于对照组的5.45%,但差异无统计学意义。结论 腰椎峡部裂患者实施峡部植骨联合短期钉棒固定治疗,可缓解疼痛和腰椎功能障碍,峡部骨性融合效果良好,同时可于峡部愈合后取出临时固定装置,最大程度降低邻近椎间盘退变风险。

Objective To observe and analyze the clinical effect of isthmus bone grafting combined with short-term nail and rod fixation in the treatment of lumbar spondylolysis. Methods Basic data of 173 patients with lumbar spondylolysis admitted to the Department of Spinal Surgery of Guangxi Autonomous Regional Corps Hospital of Chinese People’ s Armed Police Force from January 2010 to December 2022 were analyzed retrospectively. According to the treatment methods, the patients were divided into reference group (isthmus bone graft +U-shaped titanium rod fixation, n=55) and study group (isthmus bone graft+short-term nail and rod fixation, n=118), and the operation completion, pain and lumbar function, lumbar disc degeneration and isthmus bone healing were compared. Result There was no statistical difference in sex, age, operation time or intraoperative blood loss between the two groups (P＞0.05).The isthmus healing time in the study group [(10.65±0.68) months] was shorter than that in the reference group [(13.40±1.16) months], and the hospitalization time in the study group [(14.43±2.32) d] was shorter than that in the reference group [(16.51±2.81) d], with statistical significance (P＜0.05). After operation, the scores of VAS and ODI in the two groups decreased significantly, but there was no statistical value (P＞0.05). The rate of isthmus nonunion in the study group was 6.78%, which was lower than that in the reference group (20.34%), and the difference was statistically significant (χ²=8.298,P＜0.05). The degeneration rate of adjacent intervertebral disc in the study group was 2.54%, which was slightly lower than that in the reference group (5.45%), and the difference was not statistically significant (P＞0.05). Conclusions For patients with lumbar spondylolysis, isthmus bone grafting combined with short-term nail and rod fixation can effectively relieve patients’ pain and lumbar dysfunction, showing a good isthmus bone fusion effect. At the same time, temporary fixation devices can be taken out after isthmus healing, which minimizes the risk of degeneration of adjacent intervertebral discs.