正中旁入路钉钩系统固定直接修补青少年腰椎弓峡部裂

目的：观察应用椎弓根钉-椎板钩系统内固定治疗青少年腰椎峡部裂的临床疗效。方法：自2003年8月至2008年12月应用钉钩系统加压固定结合自体髂骨植骨融合治疗28例腰椎峡部裂患者（男13例,女15例;年龄15～26岁,平均21.6岁）,包括L3、L4崩裂3例,L4、L5崩裂5例,L4崩裂8例,L5崩裂12例。患者术前均腰痛且持续6个月以上。根据手术前后的X线、CT检查和Macnab评分标准,评定该术式的融合率及临床效果。结果：28例均获随访,时间9～24个月,平均14.9个月,经X线及CT检查,28例椎弓根峡部均获得骨性融合。根据Macnab评分标准：优22例,良5例,可1例。结论：采用钉钩系统固定直接修补青少年腰椎弓根峡部裂缩短了手术时间,减少了出血,尽可能多地保留了脊柱后部结构,避免了医源性的脊柱失稳,术后椎节即刻获得稳定并保留了病椎相邻椎间盘的活动度,取得了满意的临床疗效。

Direct repair of adolescent lumbar spondylolysis using a pedicle srew-laminar hook system by paramedian approach

Objective: To discuss the indication and clinical effect of direct repair of adolescent lumbar spondylolysis by screw-laminar hook system. Methods: From August 2003 to December 2008,28 patients (13 males and 15 females,ranging in age from 15 and 26 years,averaged 21.6 years) with lumbar spondylolysis were treated with isthmic bone grafting and internal fixation with a pedicle screw-laminar hook system. Three patients had spondylolysis at L₃,L₄;5 patients had spondylolysis at L₄,L₅;8 patients had spondylolysis at L₄;and 12 patients had spondylolysis at L₅. All the patients had low back pain and lasted over 6 months. According to preoperative and postoperative plain radiograph,CT scan and Macnab criteria,the fusion rate and clinical effect of this technique were evaluated. Results: All the patients were followed up with a mean period of 14.9 months,ranging from 9 to 24 months. All the patients had bony union according to the X-rays and CT scan. According to the calculation results of Macnab criteria,22 patients got an excellent result,5 good and 1 fair. Conclusion: The direct repair of adolescent lumbar spondylolysis with pedicle screw-laminar hook system can shorten length of operation,decrease blood loss,preserve more posterior structures of spine and avoid iatrogenic instability of spine. The postoperative immediate stability of vertebral segment is acquired and the mobility of adjacent intervertebral discs is reserved. The screw-laminar hook system for the treatment of adolescent spondylolisthesis can get satisfactory clinical results.