Steffee手术治疗崩裂性腰椎滑脱症的远期疗效

目的研究 Steffee手术治疗崩裂性腰椎滑脱症的远期疗效并分析术前、术后影像学特征。方法 34例崩裂性腰椎滑脱症患者全部实施 Steffee手术及后外侧融合术 (posterolateral fusion, PLF),并进行影像学观测,其指标包括滑脱率、滑脱角、椎间隙高度、椎间孔高度、融合率、断钉率和主、客观疗效评价。结果 Steffee手术加 PLF,术后 45.1％滑脱复位,椎间隙、椎间孔高度增加,滑脱角改善;随访 3年～ 8年 8个月,平均 6年 5个月,矫正度有一定程度的丢失,融合率为 88.2％,断钉率为 2.9％;临床疗效主观评估优良率高于客观评估。结论崩裂性腰椎滑脱伴神经根症状建议充分减压,最大限度复位,滑脱角大者应行椎体间支撑植骨融合。疗效评估以客观计分方式为佳。     

不同手术方式治疗腰椎滑脱症的比较

目的：比较采用不同内固定及植骨融合方式治疗腰椎滑脱症的手术疗效及适应证。方法：应用后路椎弓根螺钉复位内固定后．分别采用后外侧植骨融合术、后路椎体间植骨融合术及前路椎体间植骨融合术治疗不同类型及合并症的腰椎滑脱症患者67例，比较不同术式的手术时间与出血量、手术疗效与并发症、滑脱椎体复位率与复位丢失率以及椎间隙高度。结果：后路椎弓根钉固定加椎体间植骨融合术手术时间最长、出血量最多。手术总体优良率为88．71％，三种术式间无差异。所有椎体间植骨组植骨融合良好，椎间隙高度维持良好，滑脱椎体复位无丢失；12例后外侧植骨者平均复位丢失率为11．24％，2例椎弓根螺钉松动，2枚椎弓根螺钉断裂。结论：退变性腰椎滑脱者宜选用后路椎弓根钉固定加后外侧植骨融合术；峡部裂性腰椎滑脱者宜选用后路椎弓根钉固定加椎体间植骨融合术；腰椎滑脱翻修者宜选用后路椎弓根钉固定加前路椎体间植骨融合术     

Steffee钢板治疗腰椎滑脱症14例报告

腰椎滑脱是引起下腰痛和腿痛的常见病。自91年8月至94年8月应用Steffee钢板整复固定,植骨融合治疗腰椎峡部不连致真性滑脱14例,经随访效果良好,报告如下。 临床资料 一、一般资料 本组14例,男6例,女8例。年龄34～59岁,平均48岁。滑脱平面:L_4滑脱3例,L_5滑脱11例。滑脱度数:Ⅰ°5例,Ⅱ°7例,Ⅲ°1例。12例病人有腰     

腰椎滑脱症外科治疗策略选择

目的探讨不同类型腰椎滑脱症及合并症的手术治疗方式、疗效及优缺点。方法2000年2月～2004年4月应用后路椎弓根螺钉复位内固定后，分别采用后外侧植骨融合术、后路椎体间植骨融合术及前路椎体问植骨融合术治疗不同类型腰椎滑脱症及合并症的患者78例，比较术后及随访时疗效、滑脱椎体复位率、椎间隙高度恢复率、植骨融合率以及复位丢失率。结果术后28例Ⅰ度滑脱及37例Ⅱ度腰椎滑脱患者获得解剖复位．9例Ⅱ度滑脱及4例Ⅲ度腰椎滑脱患者矫正至Ⅰ度滑脱。随访时总体优良率为89．72％，42例椎体间植骨患者植骨融合良好，滑脱椎体复位无丢失，椎间隙高度维持良好；36例后外侧植骨者有12例复位丢失，2例椎弓根螺钉松动，2枚椎弓根螺钉断裂：结论对小于Ⅱ度退变性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉复位固定加后外侧植骨融合术；对峡部裂性腰椎滑脱合并腰椎管狭窄者宜选用后路椎弓根钉固定加椎体间植骨融合术；对Ⅱ度以上峡部裂性单纯腰椎滑脱者以及腰椎滑脱翻修者宜选用后路椎弓根钉固定加前路椎体间植骨融合术。     

经椎弓根内固定器治疗腰椎没脱

目的：探讨应用经椎弓根内固定器械治疗腰椎滑税的临床效果。方法：回顾性分析62例腰椎滑脱患,均行椎弓根钉内固定手术治疗。其中Steffee钢板法29例,RF固定法21例及CCD加Cage融合术12例。结果：平均随访2．6年（6个月－5年）,疗疚按Steffee分级：优36例（占58％）,良21例（占34％）,中5例（占8％）。结论：椎弓根钉固定系统是治疗腰椎滑脱的有效方法,其中CCD加Cae椎间植骨融合是治疗腰椎滑脱的一种全新方法,效果优良。     

Steffee系统手术治疗腰椎滑脱症

目的 :应用 Steffee系统手术治疗腰椎滑脱。方法 :采用 Steffee椎弓根钢板螺钉系统治疗腰椎滑脱 2 7例。结果 :2 7例获得随访 ,随访时间 6个月～ 6年 (平均 3年 6个月 ) ,按邹德威评价标准优 18例 ,良 8例 ,可 1例 ,优良率 96 .3%。结论 :Steffee内固定系统具有复位良好、固定牢固 ,可用于 °～ °腰椎滑脱     

后路复位固定加360度植骨融合治疗腰椎滑脱症

目的探讨后路复位固定加360度植骨融合治疗腰椎滑脱症的疗效。方法36例腰椎滑脱患者，按Meyerding分度：Ⅰ度滑脱20例，Ⅱ度滑脱10例，Ⅲ度滑脱6例，均伴有不同程度的腰椎不稳和神经症状，行后路椎弓根钉复位固定加360度植骨融合术治疗。结果36例均获12～24个月随访，平均随访时间18个月。根据Ashor的疗效观察项目：优：28例，良6例，可2例，差0例，优良率达94．4％。结论后路复位固定加360度植骨融合术是一种值得推荐的治疗腰椎滑脱的手术方法。     

腰椎退行性滑脱不同治疗方法的疗效分析

目的：探讨五种不同方法治疗腰椎退行性滑脱症的疗效。方法：63例患者中采用保守治疗（A）3例,椎管减压术（B）25例,椎管减压加Hartshill框架复位固定“H”型植骨融合术（C）12例,椎管减压加Dick钉复位固定横突间植骨融合术（D）10例,椎管减压加Steffee钢板复位固定椎体间植骨融合术（E）13例。结果：随访3个月至10年,平均12．5个月,根据疗效评定标准,A,B,C,D,E五种方法的优良率分别为66．7％,92．0％,41．7％,70．0％和92．3％。结论：保守治疗对大多数患者有效;稳定型患者在彻底减压的基础上应尽可能地保留脊柱后柱的稳定结构;三种内固定器中Steffee钢板更符合滑脱复位固定的要求。     

经椎弓根螺钉内固定在脊柱外科中的应用

经椎弓根螺钉脊柱内固定是脊柱外科中有效的新的手术方法,本文应用Steffee手术治疗脊柱滑脱和利用Dick手术治疗外伤性脊柱后凸畸形共23例。Steffee手术平均复位率为64.5％,优良率78％,Dicd手术Cobb角平均改善22°。本手术减压彻底,固定可靠,效果满意,是一种可靠的手术方法。     

360°环状融合术在腰椎滑脱治疗中的应用

目的探讨360°环状融合术在腰椎滑脱症手术治疗中的方法、技巧和临床疗效。方法我科自2002年1月至2007年4月,用360°环状融合术治疗腰椎滑脱症共42例,所有病例常规行X线正侧位片及MRI等检查,证实有Ⅰ～Ⅲ度的滑脱,合并有不同程度的椎管狭窄和椎间隙狭窄,按Newman分类,峡部裂滑脱29例,退行性滑脱13例,按Meyerding分度,Ⅰ度9例,Ⅱ度26例,Ⅲ度7例。滑脱部位：L427例,L512例,L33例。结果本组42例均获得1～6年随访,平均随访时间为2．1年。全部病例达解剖复位,术后349个月获植骨融合,平均融合时间为4．7个月,植骨融合率为100％。随访期内Cage无松动、位移、下沉,RF钉无松脱、折弯、断裂等情况,无滑脱复位和椎间高度的丢失。临床疗效评定,优33例,良7例,可2例,差0例,优良率为95．2％。结论360°环形融合术有利于彻底神经减压和滑脱节段的解剖复位,有利于消除滑脱节段的不良剪切应力,增加了植骨融合的面积和植骨量,提高了融合速度和融合质量,达到维持脊柱永久稳定的目的,是治疗腰椎滑脱症一种较好的方法。     

Pseudarthrosis repair. Autogenous iliac crest versus femoral ring allograft

Pseudarthrosis repair in the lumbar spine is one of the most challenging problems faced by spine surgeons. Historically high failure rates with posterior repair have led to the use of anterior lumbar interbody fusion with tricortical iliac crest autograft in these difficult cases. More recently, femoral ring allografts packed with autograft bone have been advocated as another method that would decrease donor site morbidity. Two series of patients underwent anterior lumbar interbody fusion with anterior instrumentation to repair pseudarthrosis (Group I, 33 patients with tricortical autogenous iliac crest and Group II, 20 patients with femoral ring allografts). At minimum 2-year followup, there was no difference in fusion rates (Group I, 32 of 33 versus Group II, 20 of 20). Patients in Group I had radiographic fusion develop more rapidly than patients in Group II (12 months versus 18 months), but a significant proportion of patients in Group I (35%) had an average of 2 mm of graft subsidence. Despite excellent fusion rates in both groups, functional outcomes were not as good with only 28% of patients in Group I and 36% of patients in Group II returning to work. Using anterior instrumentation, anterior interbody fusion offers an excellent method to repair pseudarthrosis using femoral ring allografts or autogenous iliac crest. However, femoral ring allografts offer the potential to decrease donor site morbidity, allowing the surgeon to treat multiple spine levels.     

PEEK椎间融合器在腰椎滑脱中的应用

目的探讨PEEK椎间融合器加椎弓根内固定技术治疗腰椎滑脱症的临床疗效。方法41例腰椎滑脱患者采用全椎板减压、椎弓根器械复位固定、椎体间放入PEEK融合器植骨融合。结果全部获得随访，时间12～54个月，40例植骨获得椎体间融合，融合时间6～24个月，融合率97．6％。临床疗效按Macnab标准评定：优17例，良21例，可2例，差1例，优良率达92．7％。结论PEEK椎间融合器植骨融合是一种较为实用的融合方式，避免了取自体髂骨带来的问题，在生物力学上保持腰椎生理前凸、提高腰椎生物力学功能，对恢复脊柱稳定性具有积极作用。     

后路病灶清除、椎体间融合及器械内固定术治疗胸腰椎结核性脊柱炎

目的探讨后路病灶清除、椎体间融合及器械内固定术治疗结核性脊柱炎的安全性和有效性。方法 17例胸腰椎结核患者接受后路病灶清除、椎体间融合和椎弓根钉固定术。采用Frankel神经功能分级和Kirkaldy-Willis标准来判断疗效,测量术前和术后Cobb角的变化。结果术后随访时间12～66个月。随访期内无结核症状加重及手术相关并发症。Frankel分级：术前C级4例恢复至E级2例、D级1例,1例无恢复;术前D级8例恢复至E级7例,1例无恢复。Kirkaldy-Willis标准：优9例,良5例,可3例,优良率为82.4%。后凸角术前3°～23°,末次随访时-6°～11°,差异有统计学意义（P〈0.05）。结论对病变局限的胸腰椎结核,一期后路病灶清除、椎体间融合后路内固定术能够同时完成病灶清除、稳定脊柱结构,防止矫正损失,是有效的手术方法。     

Unilateral transforaminal posterior lumbar interbody fusion.

A prospective analysis of consecutive patients who had lumbar fusion using the unilateral transforaminal posterior lumbar interbody fusion with pedicle screw fixation is presented to assess the clinical and radiographic outcomes of the transforaminal posterior lumbar interbody fusion procedure and describe the technique and indication in the treatment of degenerative disease of the lumbar spine. Forty patients treated with transforaminal posterior lumbar interbody fusion for degenerative diseases of the lumbar spine (with anterior column deficiency) were followed up for a minimum of 3 years (mean, 3.4 years; range, 3-3.9 years). Radiographic assessment included plain and flexion and extension radiographs. Clinical outcome was based on pain relief, ability to do activities of daily living, and return to work. Thirty-six patients (90%) had solid fusions and at latest followup, segmental lordosis has increased in all patients. Eighty-five percent of patients had excellent or good clinical outcome(s). The unilateral transforaminal posterior lumbar interbody fusion provides bilateral anterior column support through a unilateral approach. The patients had high fusion rates and patient satisfaction as reported with similar complications found in other methods commonly used for spinal decompression and stabilization.     

后路减压融合内固定术治疗退变性腰椎椎管狭窄合并节段性腰椎不稳的临床疗效

目的：观察后路腰椎椎管减压、椎弓根螺钉内固定并椎体间植骨融合术,治疗退变性腰椎椎管狭窄合并节段性腰椎不稳定患者的临床疗效。方法2006年1月～2011年12月收治的82例退变性腰椎椎管狭窄合并节段性腰椎不稳的患者,行后路减压融合内固定术治疗。采用Oswestry功能障碍指数（Oswestry disability index, ODI）,疼痛视觉模拟量表（visual analogue scale, VAS）和日本骨科学会（Japanese Orthopaedic Association,JOA）评分评估临床疗效。同时行影像学检查,测量椎间隙高度,用Bridwell方法评价腰椎融合情况。结果平均随访48个月,术后腰痛VAS评分、腿痛VAS评分、JOA评分、ODI、椎间隙高度均较术前明显改善,差异有统计学意义（P＜0．01）。末次随访时,根据Bridwell腰椎融合评价标准,Ⅰ级和Ⅱ级为80例（97．5％）。末次随访时,X线片、MRI检查发现4例螺钉松动断裂但已骨性融合（4％）,2例植骨未融合,椎间隙高度降低（2％）。疗效评定优24例,良46例,可8例,差5例,优良率为85．4％。结论减压融合固定治疗退变性腰椎椎管狭窄症合并节段性腰椎不稳远期疗效肯定,但应把恢复该节段的稳定作为重点。     

Reconstruction of the lumbar spine using AO DCP plate internal fixation

Augmentation of lumbar spine fusion with internal fixation using pedicle screw systems has gained wide currency because it offers rigid stabilization to foster fusion healing. The AO DCP plate has been employed in Europe as a spinal implant with pedicle fixation using 6.5 mm, full-threaded cancellous bone screws with success. This report details the experience of using this device for lumbar spine fusion in a series of 46 North American patients with a mean follow-up of 1.25 years (range 1-2.5 years). Thirty-one patients had had prior lumbar spine surgery with poor outcomes, and 15 had had no prior surgery. All were treated surgically for lumbar degenerative disease with canal decompression, internal fixation with AO plates, and fusion with autologous bone grafting posterolaterally. Complications included two early and one delayed wound infection; five cases of screw loosening; three cases of screw breakage; and three cases of screw impingement upon a nerve. Results of surgery in 17 patients with failed interbody fusion included good to excellent pain relief in 59%, and solid fusion in 76%. In 14 patients with failed posterior surgery the good to excellent pain relief rate was 79%, and the fusion rate was 86%. In 15 patients undergoing primary surgery there was 89% good to excellent pain relief and a solid fusion rate of 87%. The benefits accruing from augmentation of the fusion with internal fixation using AO DCP plates are positive and justify its continued use. Complications encountered in the early experience have been significantly reduced in subsequent series, indicating the existence of a "learning curve" effect which would mandate specific training of spinal surgeons in the technique.     

腰椎滑脱症翻修手术(附21例报告)

目的探讨腰椎滑脱症初次手术失败原因、翻修手术方式及疗效。方法回顾分析2003年4月～2006年10月21例腰椎滑脱症翻修手术病例,针对初次手术失败的原因,分别应用后路椎弓根螺钉复位内固定加椎体间植骨融合术、后路椎弓根螺钉复位内固定加前路椎体间植骨融合术以及后路椎弓根螺钉复位内固定加前路游离腓骨移植椎体间植骨融合术进行再次手术,比较术后疗效、滑脱椎体复位率以及植骨融合率。结果本组全部患者翻修手术后均获随访,时间为4～48个月,平均32.6个月,总体优良率为90.48%,所有翻修手术病例植骨融合良好,植骨融合最短时间为3.8个月,最长时间为6.4个月,滑脱椎体再次复位后矫正度无丢失,椎弓根螺钉无松动及断裂。结论腰椎滑脱症初次手术失败原因主要与手术方式选择不当、忽视植骨融合的质与量以及手术操作不当有关,只要翻修手术方式得当、术中仔细操作、合理应用内固定及植骨融合材料,仍能取得满意疗效。     

经两侧腰椎板间开窗分割切除椎体后缘大块骨赘的研究

1992年以来,采用自行研制的专用器械经两侧腰椎板间开窗分割切除椎体后缘大块骨赘21例,椎管横截面比术前平均扩大2.2倍,优良率达95.2％。该手术在较大程度上保留了腰椎后部结构的完整性,术后未发生腰椎不稳。在腰椎管前壁,椎内动脉前支与椎内静脉前丛共同围成一个以椎间盘为中心的“无血安全区”,在此区对椎体后缘骨赘施行分割切除,出血少,操作方便。本文对手术方法、指征及并发症预防进行了探讨。     

Telamon融合技术在下腰椎不稳治疗中的作用

目的回顾性分析了Telamon融合技术在治疗下腰椎不稳定方面的作用。方法本组共68例，均为单节段病变，平均年龄49岁，腰椎椎弓崩裂伴滑脱者27例，腰椎退变性不稳者41例，术前病程平均28．6月，Oswestry残疾指数平均48．5%。所有病例均行后路减压、椎弓根螺钉内固定及Telamon椎体间融合术，其中全椎板切除者5例，双侧椎板间扩大开窗者63例。结果术后随访平均11．8个月，最后随访时Oswestry残疾指数平均7．5％，复查X线片均获良好的骨性融合，无明显不稳定征象。结论Telamon融合技术能提供良好的骨性融合并维持良好的椎体间高度和腰椎的生理性前凸，由于其本身并不具有即刻稳定性，故应在坚强内固定的保护下应用，获得良好效果的关键在于正确的手术适应证。     

Anterior lumbar interbody fusion using a hybrid graft

This prospective study evaluates the clinical and radiological results of anterior lumbar interbody fusion using a femoral cortical ring allograft (FCA) packed with cancellous autologous bone (hybrid graft), combined with posterior pedicular fixation but without posterior fusion, for symptomatic degenerative disease of the lumbar spine. Twenty-eight out of 30 consecutive adult patients were followed up for a minimum period of 2 years. Intra- and postoperative complications were seen in 2 out of 28 patients (7%); no complications resulted from the allografts. Clinically, 24 out of 28 patients (85%) had a good to excellent result, one patient (4%) a fair result, and 3 patients (11%) a poor result. Radiologically, the overall fusion rate by the level was 98% in 28 patients.