| 马振江,赵长清,田建平,张凯,孙晓江,赵鑫,李华,赵杰.改良腰骶角评估骨盆前倾复位技术在儿童重度L5滑脱治疗中的应用[J].脊柱外科杂志,2016,14(1):21-25. |
改良腰骶角评估骨盆前倾复位技术在儿童重度L5滑脱治疗中的应用  点此下载全文 (Fulltext) |
| 马振江 赵长清 田建平 张凯 孙晓江 赵鑫 李华 赵杰* |
上海交通大学医学院附属第九人民医院骨科, 上海 200011
*通信作者 |
| 基金项目：国家自然科学基金项目(81071453,81272038) |
| DOI：10.3969/j.issn.1672-2957.2016.01.005 |
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| 摘要： |
| 目的 总结分析骨盆前倾复位技术在儿童重度L5滑脱手术中的应用技巧,结合改良腰骶角(modified lumbosacral angle,mLSA)评估腰骶部畸形的纠正情况。方法 回顾性分析2009年6月-2013年10月本院手术治疗的22例重度L5滑脱(滑脱率>50.0%)儿童患者的临床资料,其中男2例,女20例;年龄5~14岁,平均11.2岁;随访12~52个月,平均30个月。所有患者术中均予骨盆前倾复位技术复位滑脱椎体,纠正腰骶部后凸畸形。手术前后摄站立位全脊柱正侧位X线片,测量mLSA,评估椎体滑脱复位情况及后凸畸形纠正情况;行CT三维重建评估椎间融合情况;应用日本骨科学会(Japanese Orthopaedic Association,JOA)评分评估临床疗效。结果 术后滑脱率1.0% ~26.0%,平均7.45%,与术前相比差异具有统计学意义(P<0.05)。mLSA术前为-(24.80°±8.42°),改善至术后前凸20.40°±6.27°,末次随访时为前凸19.80°±5.17°;JOA评分由术前(7.68±1.55)分,改善至术后(16.68±1.66)分,末次随访时为(15.77±1.85)分,术前与术后评分差异具有统计学意义(P<0.05)。术后1年植骨融合率95.45%;并发症发生率9.09%(2/22),其中脑脊液漏1例,L5神经根牵拉损伤1例。结论 改良腰骶角测量评估骨盆前倾复位技术能有效复位滑脱椎体,纠正局部旋转畸形。 |
| 关键词：儿童 腰椎 脊椎滑脱 内固定器 脊柱融合术 |
| Application of pelvic antevertion reduction evaluating by modified lumbosacral angle for treatment of severe spondylolisthesis in children Fulltext |
| MA Zhen-jiang ZHAO Chang-qing TIAN Jian-ping ZHANG Kai SUN Xiao-jiang ZHAO Xin LI Hua ZHAO Jie* |
Department of Orthopaedics, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
*Corresponding author |
| Fund Project: |
| Abstract: |
| Objective To investigate the technique of pelvic antevertion reduction by posterior approach for severe spondylolisthesis in children, and to evaluate the effect of vertebral reduction by modified lumbosacral angle(mLSA).Methods From June 2009 to October 2013, a total of 22 children with severe spondylolisthesis of L5/S1(slippage ratio>50.0%) were treated with operative reduction, fixation and fusion through posterior approach.There were 2 males and 20 females at the mean age of 11.2 years(ranged 5-14 years) with a mean follow-up period of 30 months(ranged 12-52 months).Through posterior approach all cases were treated with reduction of slipping vertebrae via pelvic antevertion for the correction of lumbosacral kyphosis.The efficacy of this technique in the reduction of local deformity and correction of lumbosacral kyphosis were assessed with mLSA through the pre-and post-operative whole spine standing anteroposterior and lateral roentgenographs.Bone fusion was assessed by followed-up 3D-CT reconstruction.Clinical outcomes were assessed by Japanese Orthopaedic Association(JOA) scores for low back pain and leg pain.Results The postoperative slippage ratio was 1.0%-26.0%, mean 7.45%.Compared with that of the preoperative, the difference was statistically significant(P<0.05).The mLSA was improved from kyphotic-(24.80°±8.42°) before surgery to lordotic 20.40°±6.27åfter surgery, and lordotic 19.80°±5.17åt final follow-up.JOA score was improved from 7.68±1.55 before surgery to 16.68±1.66 after surgery, and 15.77±1.85 at final follow-up.All data of postoperative and final follow-up had significant difference compared with those of preoperative(P<0.05).Bone fusion rate was 95.45% by 3D-CT reconstruction at 12 months after operation.Complication rate was 9.09%(2/22).One case was complicated by cerebrospinal fluid leakage and 1 case was observed nerve root paralysis in L5.Conclusion The measurement of mLSA indicates a satisfactory reduction of slipping vertebrae.Almost complete correction of local kyphotic deformity can be achieved via sacral antevertion reduction for severe spondylolisthesis in children. |
| Keywords:Child Lumbar vertebrae Spondylolysis Internal fixators Spinal fusion |
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