单侧经椎间孔腰椎间融合治疗腰椎节段性不稳

目的探讨单侧经椎间孔后路腰椎间融合与内固定治疗腰椎不稳的临床疗效。方法本组采用单侧经椎间孔后路椎间融合与TENOR脊柱内固定系统治疗腰椎节段性不稳32例,49个节段,其中腰椎退行性滑脱7例,节段不稳伴椎管狭窄16例,节段不稳伴椎间盘突出9例。结果经6~22个月,平均12个月的随访,2个月融合节段可见模糊骨痂生长,4~6个月达骨性愈合,术后症状消失25例,显著改善5例,优良率为93%。无固定螺钉松动、断裂,无椎间高度及复位丢失情况,钛网融合器除1例放置偏后并有2 mm下沉外,其余均正常。结论单侧经椎间孔腰椎间融合术是新近发展应用的技术,与后路椎弓根螺钉系统联合应用,可使腰椎获得即刻稳定,恢复脊柱序列及椎间高度,维持腰椎生理弧度,促进植骨融合。     

GSS加椎间融合器治疗腰椎滑脱的临床分析

目的探讨后路应用通用型脊柱内固定系统（GSS）和椎体融合器（PEEK）经椎体间植骨融合术（PLIF）治疗腰椎滑脱的临床效果。方法对25例腰椎滑脱患者采用后路全椎板减压,GSS经椎弓根内固定并对滑脱椎体行复位固定,椎间融合器椎间植骨融合。结果随访12～36个月,临床优良率92.0%。12个月复查X线片均显示椎体间骨性融合。结论GSS椎弓根螺钉系统能有效撑开提拉滑脱椎体,复位满意,固定力强,并为彻底减压提供有效空间。采用椎间融合器植骨融合能有效提高植骨融合率。     

经椎间孔入路治疗退变性腰椎疾病

[目的]探讨经椎间孔后入路腰椎间融合结合内固定治疗退变性腰椎疾病的临床疗效.[方法]本组采用经椎间孔后路椎间融合与椎弓根钉棒脊柱内固定系统治疗退变性腰椎疾病27例,74个节段,其中腰椎退行性滑脱10例,节段不稳伴椎管狭窄7例,节段不稳伴椎间盘突出8例,高位椎间盘突出2例.[结果]所有病人术后经15～33个月,平均26.8个月的随访,2～3个月融合节段可见模糊骨痂生长,4～6个月达骨性愈合,依据日本JOA疗效评定标准,优21例,良4例,中2例,差0例,总优良率为94.8%.无固定螺钉松动、断裂,无椎问高度及复位丢失,无神经根及马尾神经损伤,无硬脊膜破裂.[结论]经椎间孔腰椎间融合术与后路椎弓根螺钉系统联合应用,可使腰椎获得即刻稳定,恢复脊柱序列及椎间高度,维持腰椎牛理弧度,促进植骨融合,而且能明显降低因侵入椎管而带来的各种可能发生的并发症,是治疗退变性腰椎疾病的有效手术方式.     

经后路减压、椎间融合、复位内固定治疗下腰椎滑脱症

目的评价后路椎板部分切除减压、椎间融合、复位内固定治疗下腰椎滑脱症的临床疗效。方法对32例下腰椎滑脱症患者采用后路椎弓根螺钉椎体撑开提拉复位、椎板部分切除潜行减压、椎管扩大成形、神经根松解、椎间融合器及植骨融合内固定治疗。结果患者均获随访,时间10～48个月,无严重的手术并发症。术后X线复查显示椎间高度均有不同程度的恢复,滑脱椎体完全复位或者基本复位,椎问融合器无明显移位、脱落,椎间融合满意。结论后路减压、椎间融合复位、内固定治疗下腰椎滑脱症复位率高,安全彻底的神经管减压,创伤小,融合满意,疗效确切。     

椎间植骨融合器联合椎弓根钉内固定系统治疗腰椎滑脱症

目的探讨椎间植骨融合器（cage）联合椎弓根钉系统内固定治疗腰椎滑脱症的疗效。方法回顾、总结2004年3月～2008年6月收治峡部不连性腰椎滑脱症31例,行椎弓根钉内固定系统作滑脱复位后加单侧cage椎间融合固定。随访观察固定节段有无位移,滑脱有无复发。结果随访24～72个月、平均36个月,椎间高度维持良好,固定节段无移位,滑脱无复发。结论椎间植骨融合器（cage）联合椎弓根钉系统内固定治疗腰椎滑脱症可减少术后断钉和复发的问题,是治疗腰椎滑脱症比较理想的手术方式。单侧cage即可以达到稳定椎间的作用。     

经伤椎椎弓根钉内固定系统直接复位联合cage椎间植骨融合术治疗下腰椎爆裂骨折

目的探讨下腰椎爆裂骨折后,经伤椎椎弓根内固定系统直接复位联合cage椎间植骨融合的治疗方法及临床效果。方法采用经伤椎椎弓根钉内固定系统直接复位联合应用cage椎间植骨融合术治疗下腰椎爆裂骨折26例。结果平均随访18.3个月,伤椎椎体无明显丢失,内固定牢靠、无折断、松动,cage椎间植骨融合良好。结论经伤椎椎弓根钉内固定系统直接复位联合cage椎间植骨融合术治疗下腰椎爆裂骨折,可实现三柱在三维上的同时复位,恢复伤椎高度,也可使伤椎与邻近椎体融合,增强下腰椎的稳定性,维持下腰椎的生理曲度。     

腰椎后外侧融合和BAK椎体间融合的疗效比较

目的　证明BAK椎体间融合优于后外侧融合。方法　腰椎滑脱 2 6例采用Steffee钢板和后外侧融合与腰椎滑脱 16例采用Silhouetle脊柱棒系统对腰椎滑脱复位固定和BAK椎间植骨融合器椎间植骨融合 ,比较它们的融合、复位和临床结果。结果　后外侧融合 2 6例随诊 6～ 36个月 ,临床融合率 80 8% (2 1/ 2 6 ) ,滑脱复位率 6 1% (16 / 2 6 ) ,临床疗效 :优 9例 ,良 9例 ,可 3例 ,差 5例 ,优良率 6 9%。BAK椎体间融合 16例患者随诊 6～ 2 0个月。临床融合率为 93 7% (15 / 16 ) ,滑脱复位率为87 5 % (14/ 16 ) ,临床疗效 :优 9例 ,良 5例 ,可 2例 ,优良率 90 %。结论　对腰椎滑脱的复位固定 ,Silhouetle脊柱棒系统较Steffee钢板有较多优点 ,与后外侧融合比较 ,BAK椎间融合器植入椎间隙后 ,椎体界面间固定 ,椎间隙无塌陷 ,无植骨吸收 ,能增大和维持椎间隙和椎间孔高度 ,间接扩大侧隐窝和恢复脊柱生理曲度 ,有较大的植骨床 ,有利于植骨融合 ,使患者早期下床。近期随访结果表明 ,Silhouetle脊柱棒系统固定和BAK椎间植骨融合器椎间植骨融合的临床疗效明显优于Steffee钢板固定和后外侧融合。     

经椎间孔椎体间植骨治疗胸腰椎C型旋转骨折脱位

目的 探讨后路经椎间孔椎体间融合治疗胸腰椎C型旋转骨折脱位的可行性及疗效.方法 2009年3月～2010年8月收治胸腰椎AO分型C型旋转骨折脱位患者10例,均为青年男性,伤椎累及T10～L3.AO分类C1型7例,C3型3例,神经功能按美国脊髓损伤学会（American Spinal Injury Association,ASIA）分级全部为A级.均行后路椎弓根螺钉内固定结合经椎间孔椎体间植骨融合手术治疗,术后随访神经功能恢复和植骨愈合.结果 10例患者手术时间平均130 min,术中出血平均 520 mL.术后X线片显示脊柱复位良好,植骨位置良好.随访12个月椎间植骨均获得骨性融合,4例ASIA分级A级恢复到B级,6例无恢复.结论 后路切开复位减压椎弓根螺钉内固定结合经椎间孔椎体间融合能从单一入路能同时完成胸腰椎C型旋转骨折脱位的减压、复位、固定和融合的治疗.     

腰椎后是融合和BAK椎体间融合的疗效比较

目的 证明BAK椎体间融合优于后外侧融合。方法 腰椎滑脱26例采用Steffee钢板和后外侧融合与腰椎滑脱16例采用Silhouetle脊柱棒系统对腰椎滑脱复位固定和BAK椎间植骨融合器椎间植骨融合，比较它们的融合、复位和临床结果。结果 后外侧融合26例随诊6－36个月，临床融合率80.8%(21/26)，滑脱复位率61％（16／26），临床疗效：优9例，良9例，可3例，差5例，优良率69％。BAK椎体间融合16例患者随诊6－20个月。临床融合率为93.7%(15/16)，滑脱复位率为87.5%（14／16），临床疗效：优9例，良5例，可2例，优良率90％。结论 对腰椎滑脱的复位固定，Silhouetle脊柱棒系统较Steffee钢板有较多优点，与后外侧融合比较，BAK椎间融合器植入椎间隙后，椎体界面间固定，椎间隙无塌陷，无植骨吸收，能增大和维持椎间隙和椎间孔高度，间接扩大侧隐窝和恢复脊柱生理曲度，有较大的植骨床，有利于植骨融合，使患者早期下床。近期随访结果表明，Silhouetle脊柱棒系统固定和BAK椎间植骨融合器椎间植骨融合的临床疗效明显优于Steffee钢板固定和后外侧融合。     

经伤椎椎弓根内固定联合椎间植骨融合术治疗下腰椎爆裂性骨折

目的探讨下腰椎爆裂性骨折损伤特点和评价经伤椎椎弓根螺钉系统直接复位固定、后路椎间植骨融合术临床应用的效果。方法采用经伤椎椎弓根螺钉系统直接复位内固定联合应用椎间植骨融合术治疗下腰椎爆裂性骨折24例。结果平均随访17.3个月,骨融合率达100%,患者均得到满意的复位,复位率达96.4%。近期内无明显矫正丢失,椎管矢状径达到正常范围,术后神经功能均得到不同程度的恢复,按Charles标准临床疗效优良率87.5%。结论对不稳定的下腰椎爆裂性骨折应早期手术治疗,应用伤椎椎弓根螺钉内固定联合椎间植骨融合重建术既可以增强内固定系统的牢固性,维持矫正效果,又能增加植骨融合率,是治疗严重创伤性下腰椎爆裂性骨折的理想术式。     

Lumbar lordosis

Lumbar lordosis is a key postural component that has interested both clinicians and researchers for many years. Despite its wide use in assessing postural abnormalities, there remain many unanswered questions regarding lumbar lordosis measurements. Therefore, in this article we reviewed different factors associated with the lordosis angle based on existing literature and determined normal values of lordosis. We reviewed more than 120 articles that measure and describe the different factors associated with the lumbar lordosis angle. Because of a variety of factors influencing the evaluation of lumbar lordosis such as how to position the patient and the number of vertebrae included in the calculation, we recommend establishing a uniform method of evaluating the lordosis angle. Based on our review, it seems that the optimal position for radiologic measurement of lordosis is standing with arms supported while shoulders are flexed at a 30° angle. There is evidence that many factors, such as age, gender, body mass index, ethnicity, and sport, may affect the lordosis angle, making it difficult to determine uniform normal values. Normal lordosis should be determined based on the specific characteristics of each individual; we therefore presented normal lordosis values for different groups/populations. There is also evidence that the lumbar lordosis angle is positively and significantly associated with spondylolysis and isthmic spondylolisthesis. However, no association has been found with other spinal degenerative features. Inconclusive evidence exists for association between lordosis and low back pain. Additional studies are needed to evaluate these associations. The optimal lordotic range remains unknown and may be related to a variety of individual factors such as weight, activity, muscular strength, and flexibility of the spine and lower extremities.     

改良经后路椎体间融合术治疗腰椎滑脱症

目的探讨单枚Cage加自体骨块椎间融合的改良经后路椎体间融合(PLIF)治疗腰椎滑脱症的疗效。方法自2000年12月～2006年6月,笔者在椎弓根螺钉系统复位固定的基础上用1枚Cage加1块自体骨椎间融合的手术方法治疗腰椎滑脱症46例,崩裂性滑脱24例,退变性滑脱22例。其中男25例,女21例;年龄29～67岁。部位:L3、42例,L4、523例,L5S121例。根据Meyerding滑移分度法:Ⅰ度22例,Ⅱ度19例,Ⅲ度5例。结果随访8～72个月,平均25个月。根据Nakai疗效评定标准:优23例,良22例,可1例。术后滑脱复位44例,Ⅲ度恢复到Ⅰ度2例。结论Cage加自体骨块融合的改良PLIF手术治疗腰椎滑脱症,具有固定坚强、较好维持椎间高度、良好的椎间骨融合、疗效确实等优点。     

Lumbar spondyloptosis

Summary This paper reports the long term results of 3 patients with lumbosacral spondyloptosis who were treated by closed reduction, followed by 6 to 12 weeks plaster cast immobilisation, posterior fusion and finally anterior fusion after a further 3 to 6 months. The follow up was from 7.5 to 10.5 years. Spondyloptosis was diagnosed by estimating the slip angle and the percentage slip. The initial slip angle ranged from 40° to 55° with 46%–91% slip. The average improvement in the slip angle after reduction was 82% with 74% improvement in slip. There was some loss of correction in every case by the end of treatment: the average improvement in slip angle was 59% (36%–78%) with an average 52% (25%–69%) correction of slip. Fusion was obtained in every case and the clinical results were very satisfactory.

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Résumé Cet article rapporte les résultats à long terme obtenus chez trois malades porteurs d'une spondyloptose lombo-sacrée, traités par réduction à foyer fermé, suivie d'une immobilisation en coquille plâtrée durant 6 à 12 semaines, puis par arthrodèse postérieure et finalement arthrodèse antérieure dans un délai de 3 à 6 mois. Le recul est de 7 ans et demi à 10 ans et demi. La spondyloptose a été évaluée par la mesure de l'angle et du pourcentage de glissement. L'angle initial de glissement variait de 40° à 55° avec un glissement de 46 à 91%. Le gain moyen de l'angle de glissement après réduction était de 82% avec une amélioration du glissement de 74%. Il y eut un certain degré de perte de la correction dans tous les cas en fin de traitement: le gain moyen de l'angle de glissement était de 59% (36 à 78%), avec une correction moyenne du glissement de 52% (25 à 69%). La fusion a été obtenue dans tous les cas et les résultats sont satisfaisants sur le plan clinique.

     

Lumbar spondylolisthesis

Summary The paper gives a survey, based on literature reports and our own experiences in 59 cases. According to Kilian (1853) spondylolisthesis is defined as ventral slipping of a vertebral body together with the pedicles. In pseudospondylolisthesis (Junghanns) the whole vertebra slips ventrally.Elongation of the isthmus of the pedicle or a cleft in the interarticular portion are prerequisites for spondylolisthesis. A dysplastic origin during childhood and adolescence is assumed. The relation of males to females is 2 1.Evolution of spondylolisthesis occurs during childhood and adolescence. The slipping process is finished in adults. Most often the condition is encountered in the lumbar, in particular in the lumbosacral, region. A third to one half of patients with spondylolysis (5–7%) demonstrate spondylolisthesis.Spondylolisthesis is usually an accidental finding, although the condition may lead to low back pain and sciatica. The earlier symptoms arise the gloomier usually is the prognosis. Very rarely a herniated disc is the cause of symptoms. Sciatica is mostly due to irritation of a nerve root by compression on the vertebral edge. Low back pain is caused by arthrogenic, pseudoarthrotic, and spondylotic degenerative disease.Diagnosis is established by AP, lateral, and oblique X-rays, and functional investigations. Myelogram and ossovenogram demonstrate compression of caudal sac and nerve roots.Conservative treatment consists of drugs and physical therapy, and cures one fifth of the patients. The best operative results are found after decompression and stabilisation (Cloward).Dedicated to Prof. Dr. Dr. h. c. H. W. Pia on the occasion of his 60th anniversary.     

Lumbar hemangioendothelioma

A case of hemangioendothelioma encountered in the lumbar region of a child is presented. Clinically, the tumor could not be differentiated from a dermoid cyst. This lesion must be included in the differential diagnosis of benign lumbar tumors.     

Lumbar microdiscectomy

Lumbar disc herniations are seen frequently in pain management practices. Specialists are well versed in the nonsurgical treatments for lumbar radiculopathy. Although most disc herniations would resolve without the need for surgery; it should be considered when patients have refractory pain or motor deficit. The following article discusses the surgical treatment for lumbar disc herniation—microdiscectomy. Pertinent literature has been reviewed and the surgical outcomes are highlighted.     

自制器械经皮髓核摘除术治疗腰椎间盘突出症：（11例报告）

经皮髓核摘除术治疗腰椎间盘突出症国外已较广泛的应用于临床．取得了满意的效果．此方法主要适用于单纯突出和没有上下潜行的韧带下突出．作者采用自行设计的器械治疗腰椎间盘突出症１１例，其中优７例，良２例．讨论了此方法的手术适应症，手术要点，作用机理和并发症．