直接修复法治疗青少年腰椎椎弓崩裂的临床研究进展

目的回顾和总结直接修复法治疗青少年腰椎椎弓崩裂的手术方式及临床疗效。方法查阅国内外关于直接修复法治疗青少年腰椎椎弓崩裂手术方式及临床疗效的相关文献,进行综述分析。结果直接修复法治疗腰椎椎弓崩裂仅在伤椎上进行简单且符合正常生理解剖的复位固定,维持其原有的解剖结构。按照文献报道的直接修复内固定方法(单一拉力螺钉固定、带钩螺钉固定、钢丝环扎内固定、椎弓根螺钉钢丝固定、椎弓根钉棒系统固定、椎弓根钉钩系统固定),青少年椎弓崩裂患者均取得了较好疗效。手术适应证的严格控制、内固定的正确选择是直接修复法获得良好疗效的保证。在各种方法中,椎弓根钉钩系统固定是一种已被广泛认同的内固定方式。结论椎弓根钉钩系统直接修复治疗青少年腰椎椎弓崩裂简便易行,疗效确实,且随着该技术的完善及微创技术的发展,其应用可能会更加广泛。     

椎弓根钉-椎板钩系统固定植骨治疗年轻人腰椎峡部裂

目的评价椎弓根钉-椎板钩系统内固定治疗腰椎峡部裂的临床疗效。方法对30例青少年峡部裂患者进行峡部修整,局部植骨,钉-钩系统内固定。结果30例经6-48月(平均26个月)随访,按Nakai标准评价,优良率97%。结论钉钩系统节段内固定治疗腰椎峡部裂固定可靠,植骨融合率高,是一种有效的方法,但应该严格掌握手术适应证。     

应用TSRH椎弓根钉系统治疗腰椎不稳症

目的：评价ＴＳＲＨ椎弓根钉系统在治疗腰椎不稳症中效果。方法：对２１例腰椎不稳症患者行ＴＳＲＨ椎根钉系统内固定手术,术后随诊分析。结果：２１例获平均２０．９个月的随访,植骨晤率为９５．２％,疗效满意。结论：ＴＳＲＨ椎弓根钉系统简单、固定牢靠,适用于腰椎不稳症的手术治疗。     

腰椎崩裂性滑脱椎弓钉复位固定椎体间植骨融合术

目的 比较腰椎崩裂性滑脱椎弓钉复位固定椎体间植骨融合术与椎体后外侧植骨融合术两种方法的优劣。方法 统计117例腰椎崩裂性滑脱病人行椎弓钉复位固定 植骨融合术后疗效，其中滑脱椎体复位固定 椎体后外侧植骨融合术90例，滑脱椎体复位固定 椎体问植骨融合术27例，内固定于术后一年取出。结果 术后2年脊柱滑脱程度，后外侧组为15．9％，椎体间组3．9％，后外侧组植骨融合率为92．2％，椎体问组为100％，腰腿痛症状改善的评价采用JOA标准(满分为29分)，后外侧组术后平均为22．3分，椎体间组为26．3分，后外侧组术后73．3％的人能参加一般的体力劳动和家务活，椎体间组为88．9％，后外侧组术中平均输血1000ml，椎体间组术中平均输血100ml，并发症发生率两个组无明显差异，绝大多数并发症临床上无重要意义。结论 椎弓钉腰椎复位固定 椎体间植骨融合术更符合生物力学原理，能更有效矫正腰椎滑脱，增加植骨融合率，防止术后再滑脱，改善患者症状更明显，而且手术相对简单，出血少。     

腰椎崩裂性滑脱椎弓根钉复位内固定后外侧植骨融合术

目的　比较分析椎弓根钉复位内固定 后外侧直骨融合术与单纯后外侧植骨融合术治疗腰椎崩裂滑脱的疗效。方法　统计分析我院 1987.1～ 2 0 0 0 .1,97例腰椎崩裂性滑脱病人行椎弓根钉复位内固定 后外侧植骨融合术后 2年的情况 ,内固定于术后一年取出。结果　植骨融合率为 92 .8%(7例未融合 )。腰腿痛症状改善的评价采用 JOA标准 ,术前平均为 15分 ,术后平均为 2 3分 ,(满分为 2 9分 ) ,术前 9.3%(9人 )能参加一般的体力劳动和干家务活 ,术后 75 .3%(73人 )的人能参加一般的体力劳动和干家务活。术前平均滑脱 41%,术后 (去除内固定后一年 )平均滑脱15 %,并发症发生率 6 1%,其中断钉发生率 42 .3%,绝大多数并发症临床上无重要意义。结论　椎弓根钉复位内固定 后外侧植骨融合术能有效矫正腰椎滑脱 ,增加植骨融合率 ,缩短术后卧床休息时间 ,但并发症较单纯后外侧植骨融合术多。     

椎弓根固定系统断钉断棒12例生物力学分析

椎弓根固定系统问世以来，已在脊柱治疗上取得了突破性进展。随之出现的各类并发症已受到临床医师的高度关注。就断钉断棒而言，椎弓根固定系统并不多见。我科从1994年～2003年共收治12例，报告如下，旨在探索其发生原因及预防措施。     

下颈椎椎弓根钉内固定系统治疗进展

目的综合分析下颈椎椎弓根的解剖学、下颈椎椎弓根钉的置钉方法、生物力学稳定性、适用范围及并发症等方面的基础和临床应用研究。方法广泛查阅近年来有关文献，分析总结椎弓根钉内固定的应用解剖学基础、生物力学、临床操作技能、适应证及并发症等。结果下颈椎椎弓根的解剖学特点可满足下颈椎椎弓根钉内固定的使用，下颈椎椎弓根钉内固定生物力学稳定性好，应用范围广，并发症可有效控制。结论椎弓根钉内固定为下颈椎不稳定的治疗提供了一种有效的内固定方法。     

椎弓根钉-椎板钩系统治疗青少年腰椎峡部裂的临床疗效

目的探讨椎弓根钉-椎板钩系统在治疗青少年腰椎峡部裂时的临床疗效。方法从1999-02-2011-02,应用椎弓根钉-椎板钩节段内固定及植骨修复重建青少年腰椎峡部裂22例。保守治疗至少6个月无效,术前腰痛VAS评分8.1分,术中彻底清除峡部裂之间的纤维组织、瘢痕及增生组织,切除裂部骨端的硬化骨,至断面出现渗血为止,取自体髂骨条植骨,安放椎弓根钉-椎板钩系统。结果所有患者术后随访9～48个月,平均24个月。术后恢复满意,无内固定断裂、神经损伤等并发症,术后腰痛VAS评分降到2.1分,所有病例均获得骨性愈合。结论椎弓根钉-椎板钩系统及植骨修复重建青少年腰椎峡部裂效果确实,值得推广应用。     

椎弓根钉-椎板钩系统加峡部植骨治疗青年腰椎峡部裂

峡部是指腰椎上关节突和下关节突之间最狭窄的部分。腰椎峡部裂（spondylolysis）又称腰椎峡部不连，系指椎骨与一侧或双侧的椎弓根或关节突间骨质连续性中断。如果同时椎体出现向前移动错位者，称之为腰椎峡部裂伴腰椎椎体滑脱。患者多为年轻男性，女性发病率为男性4倍，可发生在任何节段，好发L5，常发生于椎弓根下2．0～9．0mm，断端呈锯齿状或圆钝，     

椎弓根钉棒非融合固定失败5例

胸腰椎爆裂性骨折是脊柱椎体压缩性骨折的一种特殊形式,目前国内外手术治疗主要采用后路短节段椎弓根螺钉内固定技术,其固定坚强,能同时固定脊柱的前、中、后三柱,现已成为主流趋势。我院于2006年3月—2010年8月收治5例胸腰椎爆裂性     

Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and Ct-assessed study

Spondylolysis is a common entity, a minority of people affected by this disease need medical care, and only a few require surgery. Reconstruction of the pars interarticularis is an interesting alternative to segmental fusion; this technique has the advantage of preserving segmental motion. Most authors report good results for young patients without intervertebral disk or facet degenerative changes. Moreover Louis also showed good to excellent results with his technique carried out among people who presented a satisfactory disk height (equal to two thirds of normal height). This could extend the number of patients for whom pars interarticularis repair could be proposed. In this study, the limit of reconstruction was set at grade 3 of the Pfirrmann's classification. The fixation of the isthmus was done with a new kind of pedicle screw hook system. This stable and strong device is easy to use, allows an anatomic pars interarticularis reconstruction of spondylolysis and avoids a postoperative bracing. Twenty-three patients were assessed in this study, the mean age at operation was 34 (range 16-52 years) and the average follow-up was for 59 months (range 6-113 months). Eight patients showed moderate degenerative disk disease before the surgery and 12 patients had a grade 1 spondylolisthesis. The visual analogical scale, the Oswestry disability index (ODI) and the modified Prolo score were used for assessment of pain and clinical outcome before and after surgery. The results were from "excellent" to "good" for twenty patients (87%) and "fair" for three of them (13%). The consolidation of the isthmus was assessed at the end of the study (CT-scan); the fusion rate was observed in 91%. Among patients aged less than 30 years results are from "good", to "excellent" in all cases and consolidation was always observed. All of them showed normal disc signal before the surgery. In the group aged more than 30 years, the results varied from "good" to "excellent' in 73% and fusion of the defect was discovered in 82% of cases. Eight of them (73%) had moderate disk signal modification before the surgery. All people with fair results displayed moderate disk degeneration signs at MRI before surgery; but two of those three patients had a failure of defect consolidation too and it is also associated with poor results by several authors. No complication was found in this series. According to the good results reported by Louis and upto the current finding, the authors believe that pars interarticularis repair can be carried out on patients with moderate degenerative disk disease; the stage 3 of Pfirrmann's classification seems a good limit. The Bone and joint research (B.J.R. system) is readily usable by any surgeon using pedicle screw systems and having a short learning curve. No device failure has been observed in this series.     

Biomechanical and clinical study on screw hook fixation after direct repair of lumbar spondylolysis

Objective : To evaluate the biomechanical effect and clinical results of hook screw fixation after direct repair of lumbar spondylous defects in the pars interarticularis. Methods: L2-L6 spines of 8 fresh-frozen and thawed calf cadavers were used for mechanical testing. Bilateral spondylous defects were created in the L4 vertebra. The intervertebral rotation ranges between L4 and L5 were scanned and computerized in various states of motion, such as flexion/extension, lateral bending and torsional loadings applied on the intact spine and the spondylous spine when the spondylous spine was fixed with modified Scott' s fixation, hook screw fixation and Buck ' s fixation sequentially and respectively. Between July 2002 and February 2004, 14 young male patients (aged 15-31 years) suffering from symptomatic lumbar spondylolysis were treated with TSRH hook screw fixation after direct repair of the defects. MacNab criteria were used to assess their pre-and post-operative status. Results: Each fixation technique could significantly increase the intervertebral rotational stiffness and made the stiffness return to nearly the intact level. Hook screw technique provided more rotational stability than the others. Hook screw and Buck' s techniques provided more flexion/extension stability than modified Scott' s technique. Neither complication nor instrumental failure was observed in this study. The mean follow-up period was 21 months. All the patients except one acquired union during the follow-up period. Thirteen patients had a“good”or“excellent”result according to MacNab criteria. Conclusions: Hook screw fixation shows biomechanical advantages and is safe and effective for young patients with lumbar spondylolysis.     

经椎板拉力螺丝钉治疗青年腰椎峡部裂

目的 探讨应用经椎板拉力螺丝钉复位固定、峡部植骨治疗青年峡部裂的疗效。方法 对26例青年峡部裂患者进行峡部修整、局部植骨、经椎板拉力螺丝钉复位固定。结果 26例随访6个月～6年,平均随访2．5年。患者下腰痛等症状完全消失,未出现螺钉断裂,仅有2例松动,复查腰椎X线片均显示峡部已骨性愈合。优21例;良5例。结论 经椎板拉力螺丝钉是一种节段性内固定治疗腰椎峡部裂确实有效的方法,简单易行,但应该严格掌握手术适应证。     

Clinical and CT scan evaluation after direct defect repair in spondylolysis using segmental pedicular screw hook fixation.

Direct defect repair using segmental pedicular screw hook fixation was carried out in nine patients with spondylolysis and a mean age of 24.2 years. One patient was fused 3 years after isthmic reconstruction. In the remaining eight patients, after a mean follow-up of 41 months (range, 12-78), three self-evaluation scales revealed a significant (p < 0.05) improvement in clinical status. Computed tomography scans were carried out in seven patients. There was bilateral bony union in two cases, in three pars healing was unilateral, and in two the isthmic defect persisted bilaterally. No correlation was observed between the status of the pars and follow-up. We conclude that repair of defects in spondylolysis may result in a favorable clinical outcome even when anatomic reconstruction of pars interarticularis is not successful.     

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。     

镍钛记忆卡钩治疗腰椎椎弓峡部崩裂15例疗效分析

目的 探讨镍钛记忆卡钩治疗腰椎弓峡部裂及手术方法。方法 总结98年来应用形状记忆卡钩治疗腰椎弓峡部裂15例，并应用术中植骨。结果 随访6-38个月，平均14个月，X线提示峡部融合满意，优良率达100％。结论 该方法手术创伤小，内固定简单、操作方便、固定确实，植骨融合率高、并发症少，可早期下地活动。     

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