| 摘要: |
| 目的 基于不同手术治疗方式提出一种新的儿童L5峡部裂和滑脱分类方法，并探讨该分类方法的应用价值。方法 回顾性选择2012年1月至2017年9月在海军军医大学（第二军医大学）长征医院接受手术治疗的47例儿童L5峡部裂或滑脱患者。参照腰椎滑脱严重程度（Meyerding分级标准）、L5/S1椎间盘退变情况（Pfirrmann分级标准）、发育不良特征的风险程度（Mac-Thiong和Labelle提出的分类方法），将L5峡部裂和滑脱分为4型：Ⅰ型（采用椎弓根螺钉-U形棒系统行单纯峡部缺损修补，不进行节段融合）、Ⅱ型（单节段L5/S1融合型，需行后路L5/S1植骨融合内固定术）、Ⅲ型（双节段L4~S1融合型，采用椎弓根钉棒系统行L4~S1复位减压植骨融合内固定术）、Ⅳ型（L5~S2融合型，采用椎弓根螺钉系统行L5~S2复位减压植骨融合内固定术），评估各型患者术前和术后腰椎日本骨科学会（JOA）评分、Oswestry功能障碍指数（ODI）。结果 Ⅰ型患者13例（男8例、女5例）、Ⅱ型14例（男6例、女8例）、Ⅲ型11例（男4例、女7例）、Ⅳ型9例（男3例、女6例），年龄分别为（14.6±2.1）、（15.7±2.4）、（13.2±2.3）、（14.6±3.2）岁，术后2年腰椎JOA评分和ODI均较术前改善[分别为（19.2±2.1）分vs（14.7±2.5）分和（16.1±1.8）% vs（56.2±1.7）%，（20.2±1.9）分vs（14.3±2.4）分和（14.7±1.7）% vs（54.8±1.8）%，（21.1±2.2）分vs（13.3±2.4）分和（13.7±2.2）% vs（55.7±2.4）%，（20.7±1.9）分vs（11.8±2.4）分和（12.9±1.7）% vs（52.5±2.3）%]，差异均有统计学意义（P均<0.01）。结论 提出了一种新的儿童L5峡部裂和滑脱分类方法，该分类方法可以更好地指导治疗。椎弓根螺钉-U形棒系统在单纯L5峡部裂的治疗中更有优势，L5~S2融合更适用于伴有高发育不良风险的L5峡部裂和滑脱患者。 |
| 关键词: 儿童 第5腰椎 峡部裂 腰椎滑脱 分类 外科手术 |
| DOI：10.16781/j.0258-879x.2020.03.0272 |
| 投稿时间：2019-12-05修订日期：2020-02-05 |
| 基金项目:上海市科学技术委员会科研计划项目（18411964800），上海市教育委员会晨光计划（14CG37）. |
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| A classification of L 5 spondylolysis and spondylolisthesis in children based on surgical treatment |
| MA Xiao1△,YIN Jia1△,SHAO Wei2,MA Jun1,WANG Ce1,GAO Rui1,LIN Tao1,ZHOU Xu-hui1* |
(1. Department of Orthopaedics, Changzheng Hospital, Naval Medical University(Second Military Medical University), Shanghai 200003, China;
2. Department of Orthopaedics(Ⅲ), No. 359 Hospital of PLA, Zhenjiang 212001, Jiangsu, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To propose a novel classification of L5 spondylolysis and spondylolisthesis in children based on surgical treatment and to explore its availability. Methods A total of 47 children with L5 spondylolysis or spondylolisthesis, who underwent surgical treatment in Changzheng Hospital of Naval Medical University (Second Military Medical University) between Jan. 2012 and Sep. 2017, were retrospectively included. According to the severity of spondylolisthesis (Meyerding grade), the degree of L5/S1 disc degeneration (Pfirrmann grade) and dysplastic features (classification described by Mac-Thiong and Labelle), a novel classification of L5 spondylolysis and spondylolisthesis based on surgical treatment was proposed. This classification contains four types. Type Ⅰ:using pedicle screw-U rod system to repair the isthmic defect without segment fusion. Type Ⅱ (single-segment L5/S1 fusion type):requiring posterior L5/S1 fusion and internal fixation. Type Ⅲ (doublesegment L4-S1 fusion type):using pedicle screw system to perform L4-S1 reduction, decompression, fusion and internal fixation. Type Ⅳ(multi-segment L5-S2 fusion type):using pedicle screw system to perform L5-S2 reduction, decompression, fusion and internal fixation. Lumbar Japanese Orthopaedics Association (JOA) score and Oswestry disability index (ODI) were evaluated before and after surgery. Results There were 13 cases of type Ⅰ (8 males and 5 females), 14 cases of type Ⅱ (6 males and 8 females), 11 cases of type Ⅲ (4 males and 7 females), and 9 cases of type Ⅳ (3 males and 6 females). The average ages of type Ⅰ, Ⅱ, Ⅲ and Ⅳ patients were (14.6±2.1), (15.7±2.4), (13.2±2.3) and (14.6±3.2) years old, respectively. The lumbar JOA score and ODI were improved two years after surgery compared with those before surgery in type Ⅰ, Ⅱ, Ⅲ and Ⅳ patients (JOA score 19.2±2.1 vs 14.7±2.5, 20.2±1.9 vs 14.3±2.4, 21.1±2.2 vs 13.3±2.4, and 20.7±1.9 vs 11.8±2.4; ODI[16.1±1.8]% vs[56.2±1.7]%,[14.7±1.7]% vs[54.8±1.8]%,[13.7±2.2]% vs[55.7±2.4]%, and[12.9±1.7]% vs[52.5±2.3]%), and the differences were significant (all P<0.01). Conclusion A novel classification of L 5 spondylolysis and spondylolisthesis in children is proposed, and it can better guide the surgical treatment. Pedicle screw-U rod system is more effective in the treatment of simple L5 spondylolysis, and fusion from L5 to S2 is more suitable for L 5 spondylolysis and spondylolisthesis patients with high-degree dysplasia. |
| Key words: children 5th lumbar vertebrae spondylolysis spondylolisthesis classification operative surgical procedures |
