峡部植骨治疗腰椎椎弓峡部裂和腰椎滑脱

介绍一种治疗腰椎椎弓峡部裂合并轻度腰椎滑脱的手术方法。手术通过在峡部及关节突关节处植骨使快部缺损得到直接修复并使腰椎获得稳定。共治疗46例98处病变，随访7个月～4年2个月，平均13个月。94处获得骨性融合，占95．9％。计优28例，良15例，可3例。作者认为峡部植骨修复融合术与其他融合术式相比，对腰椎的正常生理活动范围干扰及手术创伤均较小，操作技术亦相对简单，对于青少年及多节段推弓峡部裂患者尤为适合，但要求植骨确实可靠，以防骨不连发生。     

Buck法螺钉固定联合椎板-横突植骨术治疗腰椎椎弓峡部裂

目的 探讨Buck法螺钉固定联合椎板-横突植骨术治疗腰椎椎弓峡部裂合并轻度腰椎滑脱的手术效果。方法 应用Buck法螺钉同定联合椎板-横突植骨融合,治疗10例合并Ⅰ～Ⅱ度腰椎滑脱的腰椎椎弓峡部断裂。结果随访8个月～4年,均达骨性融合,腰痛等症状缓解。结论Buck法螺钉固定联合椎板-横突植骨融合技术治疗合并Ⅰ～Ⅱ度以内滑脱的腰椎椎弓峡部裂,手术创伤小,对腰椎生理影响小,疗效可靠。     

改良Buck法结合Hibbs法治疗腰椎峡部裂

目的：介绍一种治疗腰椎椎弓峡部裂合并轻度腰椎滑脱的手术方法。方法：手术通过在峡部植骨,采用Buck法和Hibbs法用螺钉固定峡部并植骨融合病变椎节的椎板、关节突使峡部缺损得到直接修复和加强并使腰椎获得稳定。结果：共治疗8列16处病变,经随访全部获得骨性愈合,达100％。结论：作者认为此方法对腰椎的正常生理活动范围干扰及手术创伤均较小,不受椎间盘退变程度影响,适应范围较广,治疗效果确实可靠。     

椎弓根螺钉钢丝内固定治疗腰椎峡部崩裂

目的 介绍一种治疗腰椎峡部崩裂的方法。方法 用椎弓根螺钉钢丝捆绑加髂骨椎板植骨治疗滑脱小于50％且无神经根症状的腰椎峡部崩裂患者。结果 用椎弓根螺钉钢丝捆绑加髂骨椎板植骨治疗10例经半年随访全部骨性愈合。结论 椎弓根螺钉钢丝捆绑加髂骨椎板植骨为滑脱小于50％的腰椎峡部崩裂且无神经根症状患者提供了一种治疗选择。     

单脊椎内固定术治疗峡部不连性腰椎滑脱症

目的　探讨一种治疗椎弓峡部不连性腰椎滑脱的可靠方法。方法　对 12例椎弓峡部不连性腰椎滑脱 Meyerding分类 °滑脱患者 ,行峡部缺损修整 ,加压植骨 ,螺丝钉、钛丝单脊椎内固定术治疗。结果　经 5～ 5 6个月的随访 ,大部分患者症状完全消失 ,无断钉 ,无复位丢失及假关节形成 ,优良率 91.7% ,植骨愈合率 10 0 %。结论　本法对治疗轻度峡部不连性滑脱是一种简单易行 ,疗效肯定 ,适宜推广的方法     

改良方法内固定加植骨治疗腰椎崩裂性滑脱临床观察

目的：介绍一种治疗腰椎峡部不连伴有轻度腰椎滑脱的手术方法：方法：手术采用单椎体棘横突间改良钢丝张力带固定加植骨修复峡部缺损使腰获得稳定,结果：我院自1993年2月－1999年6月用此方法治疗腰椎峡部崩裂19例患者,共38 处骨缺损,全部病人均获得随访,随访时间为10个月－4个5个月,平均2年1个月,骨缺损均骨性愈合,腰痛症状消失,效果满意,结论：该术式创伤较小,内固定简便,对腰骶部运动生理干扰小,对此类病人是一种行之有效的方法。     

椎弓根钉加压植骨治疗腰椎峡部不连及滑脱

目的 :探讨椎弓根钉加压植骨治疗腰椎峡部不连并轻度滑脱的疗效及原理。方法 :自1989年起治疗 2 5例 5 0处病变 ,随访 8个月～ 6年 6个月 ,平均 3.7年。结果 :5 0处均获得骨性融合 ,计优2 3例 ,良 2例。结论 :椎弓根钉加压植骨融合术与其他融合术相比 ,对腰椎的正常生理活动范围干扰及手术创伤较小 ,操作技术亦相对简单 ,不需要外固定 ,对于峡部不连及轻度滑脱患者尤为适合     

RF内固定治疗腰椎椎弓峡部不连伴腰椎滑脱症

目的 探讨RF内固定治疗腰椎椎弓峡部不连腰椎滑脱症的疗效。方法 采用后路RF复位、椎管减压、峡部、上下关节突及部分椎板植骨内固定治疗30例。结果 30例滑脱均完全复位。骨性融合率100％。根部疼痛及日常功能情况分级,疗效优良率达90％。结论 RF内固定治疗腰椎椎弓峡部不连伴腰椎滑脱症,应常规作神经根探查;锥管减压须充分;有效的内固定,滑脱完全复位;有充分植骨床面积（峡部、上下关节突关节及部分椎板）和认真的植骨床粗糙面准备及植骨材料的适当放置,以获得骨性融合。这样才能保证疗效优良。     

对治疗腰椎峡部裂和滑脱症的几种手术方法的估价——介绍加压钩钉植骨固定术

１９８７年４月～１９９１年１２月作者采用各种不同的手术方法治疗腰椎峡部裂和滑脱症共６３例，总优良率为８４．９％。经随访，对各种手术方法的效果作出估价，认为：１．腰痛伴有腰椎峡部裂或轻度滑脱患者，加压钩钉植骨固定术应是首选术式。２．有神经根压迫症状时，应作椎板切除减压木，同时作腰椎融合术．３．减压术后植骨内固定方法以后外侧（横突间融合）法简便、效果可靠。本文同时介绍了加压钩钉植骨固定手术方法。     

腰椎峡部裂和滑脱症外科治疗的探讨

报告自１９６５～１９９１年９２例有症状的腰椎峡部裂和滑脱的外科治疗。１９６５～１９７１年采用经腹椎体间前植骨融合２２例； １９７１～１９７８年采取腹膜外入路椎间植骨融合或Ｒｏｍｂｏｌｄ法后外侧融合术２０例；１９８７～１９９１年峡部裂处植骨、螺钉和横突钢丝内固定１５例，短节段经椎寻根内固定３５例，其中改良Ｄｉｃｋ法７例．Ｓｔｅｆｆｅｅ槽式钢板２８例，同时行后外侧融合。作者认为，症状性的腰椎峡部裂或轻微滑脱，峡部可直接修整植骨、螺钉和横突钢丝固定。滑脱椎可采用经椎弓根Ｓｔｅｆｆｅｅ槽式钢板螺钉得到完全或部分复位．     

Operative repair of symptomatic spondylolysis following a positive response to diagnostic pars injection

From 1989 to 1996, 275 patients (245 male and 20 female) with back pain symptoms and spondylolysis of the lumbar spine were reviewed. All patients were evaluated by a protocol that included nonoperative treatment, bone scan, and pars injection. Only those whose symptoms failed nonoperative measures, showing negative bone scan and positive pars injection, were regarded as candidates for surgical management. Pars injection with Marcaine was done, and there were 93 cases with a positive response of reproducing symptoms and symptom relief. Patients then received autogenous bone grafting and internal fixation of the pars interarticularis defect. The internal fixation devices used included translaminar screws (AO 3.5 cancellous screw) for the most frequent level of L5, hook screws for levels above L4, and augmentation with wire for cases with concomitant spinal bifida occulta. The average age of the surgical group (85 male and 8 female) was 23 years (range: 19-35 years). After a follow-up averaging 30.4 months (range: 24-48 months), fusion results were 87%. Clinical results of 85 cases (91.3%) were excellent to good; 8 cases were fair; there were no poor cases. Direct repair of the pars defect by internal fixation and bone grafting was done to preserve involved motion segment and to prevent abnormal stresses at adjacent levels. These procedures seemed to be clinically effective.     

Repair of the defect in spondylolysis or minimal degrees of spondylolisthesis by segmental wire fixation and bone grafting

Twenty-two patients with spondylolysis and minimal degrees of spondylolisthesis have been treated with repair of the defect by segmental wire fixation and bone grafting. Twenty-one patients are available for follow-up. Eighty percent of the patients obtained good to excellent results, and 90% obtained solid fusion of the pars defect. The technique would appear to have the greatest use in patients less than 30 years of age with minimal degrees of displacement.     

加压螺钉内固定植骨治疗腰椎峡部裂(附14例报告)

本文介绍一种单脊椎内植骨内固定治疗腰椎峡部裂的手术方法.手术直接在峡部裂处修整植骨,并采用通过峡部裂间隙的加压螺钉作内固定,旨在恢复椎弓连续.本组病例14例,均获得随访(术后1～6年).X线复查显示植骨愈合13例.按Henderson标准评价,临床优良率达92.8%.     

Clinical outcome after segmental wire fixation and bone grafting for repair of the defects in multiple level lumbar spondylolysis

The aim of this retrospective study was to assess clinical outcomes after segmental wire fixation and bone grafting for repair of pars defects in patients with multiple-level lumbar spondylolysis. Subjects were 7 patients (5 men and 2 women, mean age 26.7 y) with multiple-level lumbar spondylolysis treated by segmental wire fixation and bone grafting at one of our affiliated institutions between 1983 and 2004. Clinical outcomes were determined by comparing preoperative and postoperative Japanese Orthopaedic Association scores and Mancab criteria, and healing of pars defects was evaluated by radiographic and computed tomography study. The condition involved 2 levels in 5 cases and 3 levels in 2 cases. The mean postoperative follow-up period was 51.0 months. The mean Japanese Orthopaedic Association score improved significantly from 21.29 before surgery to 27.86 after surgery, and the recovery rate was 85.21%. An "excellent" result was achieved in 5 cases, a "good" result in 1 case and a "fair" result in 1 case according to the Macnab criteria. Postoperative radiographs revealed healing of all defects in 4 cases, healing of 3 out of 4 defects in 2 cases, and no healing of any defect in 1 case. Pseudoarthrosis was related to wire breakage, and patients who did not obtain complete healing were patients who did not fully comply with instructions to wear a lumbar corset or restrict activity postoperatively. Segmental wire fixation and bone grafting were shown to be effective for multiple-level lumbar spondylolysis.     

腰椎椎弓峡部裂伴I°滑脱单纯峡部植骨与椎弓根钉内固定的疗效对比研究

目的对腰椎椎弓峡部裂伴Ⅰ°滑脱行嵌入式单纯峡部植骨与植骨加用椎弓根钉内固定的临床疗效进行比较.方法对43例腰椎椎弓峡部裂伴I°滑脱患者随机行嵌入式单纯峡部植骨20例、植骨加用椎弓根钉内固定23例,随访22～115个月,平均47个月.根据随访X线片和症状改善情况,统计植骨融合率和疗效优良率,并进行比较.结果嵌入式单纯峡部植骨和植骨加用椎弓根钉内固定的融合率分别为85%和91.3%,优良率分别为85%和91.3%,统计学分析无显著差异,但前者并发症少于后者.结论对于腰椎椎弓峡部裂伴I°滑脱患者两种治疗方法均能取得满意疗效,单纯嵌入式植骨的术式简单、并发症少,但卧床时间较长.     

Pars interarticularis fusion of multiple levels of lumbar spondylolysis. A case report

Numerous surgical techniques have been described for the treatment of spondylolysis and spondylolisthesis. This case report involves the use of a technique for pars defect repair originally described by James Scott of Edinburgh. Our patient, an 18-year-old woman, was initially treated for bilateral injury to the pars interarticularis with non-operative methods, but the results proved unsuccessful. She then underwent bilateral pars repair at L3 and L4 using iliac bone grafting and wiring of the transverse processes and spinous processes of the involved vertebrae. Follow-up radiographs showed complete fusion of the right pars defects at L3 and L4 and incomplete fusion of the left pars defect. The procedure effectively restored spine stability and repaired the pars defects.     

Direct repair of spondylolysis without spondylolisthesis, using a rod-screw construct and bone grafting of the pars defect.

STUDY DESIGN: A retrospective study of patient outcome after pars repair using an original technique in patients with spondylolysis without spondylolisthesis and degenerative disk disease. OBJECTIVES: To assess the results of a new technique of internal fixation that avoids penetration of the spinal canal, temporary fixation of the lumbosacral junction, and postoperative bracing owing to stable instrumentation consisting of pedicle screws and a V-shaped rod resting against the inferior aspect on the spinous process and the posterior aspects of the laminas. SUMMARY OF BACKGROUND DATA: Previously described techniques for direct repair of a pars defect often require postoperative bracing and can require intracanal penetration of wires or hooks; screws passing directly through the defect, thereby lessening the bone surface available for bone grafting; and temporary fixation of the lumbosacral junction with a plate that must be removed. METHODS: Patients with painful pars defect not responding to conservative therapy and interfering with everyday life, sports, or work were considered to be eligible for direct repair of the spondylolysis rather than lumbosacral fusion, if there was no associated degenerative disk disease or spondylolisthesis. The surgical technique involves placement of screws on the pedicles of the involved vertebra and the fixation of the loose posterior arch with a solid rod bent in a V shape, taking purchase on the spinous process and laminas. A bone graft is placed under compression in the pars defect before the rod-screw construct is tightened. RESULTS: The first 10 patients who underwent this technique had an average follow-up of 35 months (range, 7 months to 5.3 years); mean age at operation was 26 years (range, 16-48 years). Six patients had an excellent result, returned to normal everyday life and work, and participated in sports when desired. The outcome in one patient was rated good and in one, fair. The procedure in one was considered a failure, although bone fusion seemed to have been obtained. Seven patients would recommend the operation, one would hesitate. No complications were encountered because of the specific design of the construct. CONCLUSIONS: This new technique offers the advantage of being easy and fast, it can be performed using a great number of available spinal instrumentations using rods and pedicle screws. There is no violation of the neural canal except in the case of a misplacement of pedicle screws. No postoperative brace was used, return to everyday life avoiding low back stress was immediate, and return to work or sports was possible 3 to 6 months after the procedure. This technique seems safe and effective but needs careful selection of patients, as do all other techniques for direct repair of pars interarticularis.     

有限切开复位克氏针横向固定治疗掌骨骨折

目的 探讨有限切开复位克氏针横向固定张力带纵向加压治疗掌骨骨折的方法和疗效.方法 2007年1月-2012年12月,应用有限切开复位克氏针横向固定张力带纵向加压治疗掌骨骨折26例.骨折部位：掌骨颈、掌骨中段、掌骨基底部,其中11例为多发性骨折.6例合并肌腱断裂,其中5例9根肌腱断裂予以直接缝合,1例2根肌腱缺损行掌长肌腱移植;5例伴软组织缺损,其中2例行骨间背侧皮瓣修复,3例行局部皮瓣转移修复、自体取皮植皮术.结果 术后回访,X线片显示均愈合.未发现骨折移位及畸形愈合,无针道感染发炎.上肢部分功能评定优良率80.6％.结论 应用有限切开复位克氏针横向固定张力带纵向加压治疗掌骨骨折,手术操作简单,骨折复位固定牢靠,不限制关节活动,有利于功能锻炼,材料价廉,免除二次手术痛苦,是一种方便、经济实用的治疗方法.     

Experimental study on repair of the defect of the pars interarticularis in rat with bone morphogenetic protein and fibrin glue]

The possibility of repairing the defect of the pars interarticularis (pars defect) with Bone Morphogenetic Protein (BMP) and fibrin glue was studied. The pars defect established in the 5th lumbar vertebra of Wistar rat was treated with surgical implantation of a composite consisting of BMP, fibrin glue and autologous cancellous bone. At 3, 6, 9 and 12 weeks after implantation, the osteoinductive activity in the pars defect was observed histologically and compared with that of other composite implants such as BMP with fibrin glue, autologous cancellous bone alone and autologous cancellous bone with fibrin glue. Although perfect bone fusion was not obtained with any of the composites employed, a significant increase in bone formation was seen in a composite of BMP, fibrin glue and autologous cancellous bone (p less than 0.01) as compared with that seen in the others. Consequently, implantation of BMP and fibrin glue combined with some biomaterials which support osteo-induction of BMP and stabilize the pars defect might be successfully applied to repair the pars defect.