新型多孔面螺钉研究及在腰椎峡部裂内固定的远期效果

目的　探讨新型多孔面螺钉在单个腰椎峡部裂内固定的临床远期效果。 方法　在新型多孔面螺钉理论研究的基础上，总结20年来新型多孔面螺钉内固定治疗腰椎峡部断裂患者237例，117例患者得到随访，平均随访(8.2±7.8)年。所有病例均为椎体的双侧峡部裂，其中L3 17例，L4 31例，L5 69例，无滑脱100例，伴Ⅰ°滑脱20例，Ⅱ°滑脱7例。所有病例采用神经根管减压，峡部硬化骨、疤痕组织切除术+神经粘连松解+峡部植骨+多孔面螺钉内固定术。 结果　本组117例随访时，112例症状完全消失，恢复术前工作，腰部活动不受限。Oswestry功能障碍指数由术前28.37±3.99减少至随访时5.33±2.70，术前与随访时差异有统计学意义（P<0.01）。JOA评分由术前19.00±2.78增加至随访时28.08±1.04，术前与随访时差异有统计学意义（P<0.01)。117患者的治疗改善率90.34%。峡部愈合率达99%，腰椎滑脱纠正率达80%。随访病例未出现螺钉松动及断裂现象，未发生邻近节段退变等并发症。 结论　多孔面螺钉通过直接固定峡部断裂，重建脊柱单个运动单元的完整性，有效避免了松动、断钉以及邻近节段病的发生，可长期置留体内。

Development of a new screw with porous sides and its long-term efficacy for internal fixation of lumbar spondylolysis

Objective　To investigate the long-term efficacy of using internal fixation of lumbar vertebral spondylolysis by screws with porous sides.　Methods　Applied of the new screw 237 patients with bilateral lumbar vertebral spondylolysis underwent internal fixation by the screws with porous sides; among the patients, 117 cases were followed up for a mean period of 8.2±7.8 cases. The spondylolysis was located at L3 in 17 cases, in L4 in 31 cases, in L5 in 69 cases; The spondylolysis was not accompanied by spondylolisthesis in 100 cases and was accompanied by I-degree spondylolisthesis and II-degree spondylolisthesis in 20 cases, respectively. All cases underwent decompression of nerve-root canal, excision of osteosclerosis at the lumbar pars and scar tissue, adhesion release of the nerves, bone implant at the bars and internal fixation by the screws with porous sides. Outcomes In the clinical study, 112 among the 117 cases who were followed up claimed total disappearance of symptoms, returning to daily work with no restriction of lumbar activity. Scores of Oswestry functional impairment index was reduced to 5.33±2.70 during the follow up from 28.37±3.99 before the treatment, suggesting significant statistical difference. ( P<0.01). JOA assessment scores improved from 19.00±2.78 before the treatment to 28.08±1.04 during the follow-up, suggesting significant statistical difference. The rate of improvement of symptoms, union of spondylolysis and correctness of spondylolisthesis was 90.34%, 99% and 80%, respectively. In all cases, no screw loosening, beak and degradation of adjacent lumbar segments were found.　Conclusions　The screws with porous sides can reconstruct the integrity of the motor unit of the spine through direct fixation of the fracture of the lumbar bar and stay safely in the human body in long term. Furthermore, loosening and break of the screws, and degradation of the adjacent segments after fixation can rarely happen.