峡部植骨治疗腰椎椎弓峡部裂和腰椎滑脱

介绍一种治疗腰椎椎弓峡部裂合并轻度腰椎滑脱的手术方法。手术通过在峡部及关节突关节处植骨使快部缺损得到直接修复并使腰椎获得稳定。共治疗46例98处病变，随访7个月～4年2个月，平均13个月。94处获得骨性融合，占95．9％。计优28例，良15例，可3例。作者认为峡部植骨修复融合术与其他融合术式相比，对腰椎的正常生理活动范围干扰及手术创伤均较小，操作技术亦相对简单，对于青少年及多节段推弓峡部裂患者尤为适合，但要求植骨确实可靠，以防骨不连发生。     

峡部植骨治疗单纯腰椎椎弓峡部裂

目的 :介绍单纯腰椎椎弓峡部裂行峡部植骨治疗方法。方法 :通过对 12例共 2 4处病变的手术结果进行分析。结果 :随访 6个月～ 2年 2个月 ,平均 13个月。X线片提示所有病例均获得骨性融合 ,优 9例 ;良 3例。结论 :峡部植骨融合术符合生物力学原则 ,对腰椎的正常生理活动范围干扰小、操作简单、创伤也较小 ,是治疗单纯腰椎椎弓峡部裂的理想方法。但要求术中植骨确实可靠 ,术后正确指导康复。     

腰椎峡部裂的治疗策略

腰椎峡部裂是引起儿童及青少年腰痛症状的常见原因。腰椎峡部裂的治疗包括保守治疗与手术治疗。保守治疗包括休息、限制活动、佩戴支具及理疗等。手术治疗分为两类,峡部修复+节段内固定术与腰椎融合术。本文就腰椎峡部裂常用的治疗方法作一综述。     

青少年腰椎峡部裂性腰痛的手术治疗

目的：探讨青少年下腰椎峡部裂的手术方法及其价值。方法：共11例，年龄15～20岁，平均18岁。手术采用前、中、后柱360。脊柱融合方法治疗该疾病，术后3d开始下床活动，腰围固定2个月。结果：手术平均时间为3h，失血量为250ml，术后平均随访10个月，所有患者均在术后3个月愈合。结论：青少年下腰椎峡部裂，360。脊柱融合方法治疗该疾病，均取得了良好疗效，是一个比较理想的手术方式。     

腰椎峡部裂与脊椎滑脱

腰椎峡部裂与脊椎滑脱北京军区总医院骨科（１００７００）胥少汀腰椎峡部裂的发生率约在４％左右，并有一些发展成脊椎滑脱，近些年来对其重视，外科治疗方法有了一些进展。本院自五十年代开始治疗此症，病例大多系峡部疲劳骨折不连接，故又称峡部不连。一、病理生理（一...     

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。     

节段内修复手术治疗腰椎峡部裂及轻度峡部裂性滑脱的疗效分析

目的探讨节段内直接修复手术对于腰椎峡部裂及轻度峡部裂性滑脱的疗效。方法回顾2010-01-2015-06收治并手术治疗的55例腰椎峡部裂及小于Meyerding I°峡部裂性滑脱病例。按术式分为修复组(15例)及融合组(40例),统计各组术前及末次随访时的VAS评分、ODI指数以及腰椎活动度,同时统计各组手术时间及术中出血量以及并发症情况,结果以SPSS 19.0进行相关数据统计分析。结果两组患者一般资料无显著性差异(P0.05),末次随访两组VAS评分及ODI指数均较术前显著改善(P0.05),末次随访两组间VAS评分及ODI指数无显著差异(P0.05),但修复组腰椎活动度大于融合组(P0.05),修复组翻修率明显高于融合组(P0.05)。结论对于单纯腰椎峡部裂及伴轻度滑脱的患者,修复手术与融合手术疗效相当,且其有利于保留腰椎的活动度,但其手术翻修率相对较高。     

单纯峡部植骨治疗腰椎椎弓峡部裂初步报告

腰椎椎弓峡部裂是下腰痛的常见原因之一。随着椎弓根内固定技术和器械的发展,使该病的手术治疗有了很大的进步。但即使短节段固定对脊柱的生理状况也有影响,并容易造成相邻节段的椎间盘退变。此外,椎弓根内固定器械费用昂贵,手术并发症多,且需要二次手术取出,故并非适合所有患者。我院1998～2 0 0 2年采用单纯峡部植骨治疗腰椎椎弓峡部裂患者10例,疗效满意现报告如下。1　临床资料1.1一般资料　本组共10例,其中,男性7例,女性3例。年龄18～30岁,平均2 5 .6岁。病程2个月～3年。1.2临床表现　所有病例均有程度不等的腰骶部疼痛,站立、行走时加…     

腰椎椎弓峡部裂的病因与手术治疗

椎弓峡部裂也称为椎弓崩裂(spondylo-ysis),多见于第5腰椎。该症以椎弓峡部(即关节突间部)的一侧或两侧缺损为主要病理特征,严重时还可发生该节椎体、椎弓及上关节突等的向前滑脱,系一种常见的脊柱疾患,尤其在青少年中有较高的发病率。对于腰椎椎弓峡部裂的探讨已有将近一个半世纪的历史,本文就近年来在该症病因及手术治疗方面的研究进展作一综述。 病　因 腰椎椎弓峡部裂的病因目前尚不十分明确,各家观点亦很不一致,归纳起来主要包括以下几个方面的因素。 1　创伤因素　虽然部分患者有明确的外伤史,但大多在伤前即存在腰背疼痛,且伤情并不…     

腰椎峡部裂的影像学检查与诊断

成人腰椎峡部裂的发病率为３％～１０％。由于腰椎峡部与三维空间上的任何一个平面都不平行,放射学检查比较困难。目前已有多种方法可以获得峡部额状面及侧位平片。一般认为,４５°侧斜位片是诊断腰椎峡部裂的重要手段。但是,只有当射线束与峡部裂骨折平面相平行时才能...     

腰椎间盘突出症合并马尾神经损伤的分型及其预后

手术治疗腰椎间盘突出症合并马尾神经损伤患者60例，随访42例。提出了按发病急援和损伤程度为标准的分型方法，讨论了不同类型患者手术治疗方式的选择及预后。     

CODI评定青年战士腰椎间盘突出症的康复疗效

目的：汉化Oswestry功能障碍指数（Chinese Oswestry disability Index.CODI)应用于青年战士腰椎间盘出症康复疗效评定。方法：理疗康复室27例患者。治疗前用CODI及综合评分表记分，康复治疗后再次评分。分别计算其优良率，并进行相关分析。结果：CODI指数与综合评分表优良率相比，符合率高，无显著差异性。结论：CODI指数评定青年战士腰椎间盘突出症康复疗效稳定、可靠。可作为一项重要参考指标。     

腰椎棘突偏斜与年轻患者腰椎间盘突出的相关性研究

目的：探讨腰椎棘突偏斜与年轻患者（<30岁）腰椎间盘突出之间的相关性。方法：对2015年3月至2022年1月收治的30例年轻腰椎间盘突出患者（年轻组）进行回顾性分析。同时筛选纳入中老年腰椎间盘突出患者（中老年组）和非退行性病变的年轻脊柱脊髓疾病患者（年轻非退变组）各30例作为对照组。在CT上测量目标棘突的偏斜角度,通过各类分组进行统计学分析。结果：年轻组病变节段的棘突偏斜角度为（3.89±3.77）°,中老年组病变节段的棘突偏斜角度为（3.72±2.98）°,两组比较差异无统计学意义（P=0.851）。年轻非退变组棘突偏斜角度为（2.20±2.28）°,明显小于年轻组患者（P=0.040）。年轻组病变节段的上位椎体棘突的倾斜角度为（4.10±3.44）°,与中老年组的（3.47±2.87）°比较差异无统计学意义（P=0.447）。年轻组有19例患者病变节段和上位椎体棘突的倾斜方向相反,而中老年组仅有7例患者出现这种情况,两组比较差异有统计学意义（P=0.002）。年轻患者腰椎间盘突出方向与病变或者上位腰椎的棘突偏斜方向无明显关系（P>0.05）。结论：棘突偏斜可能是年轻人患腰椎间盘突出的危险因素。相邻腰椎棘突的偏斜方向相反是年轻患者的重要解剖特征,在此基础上会产生椎旁肌发育失衡,容易诱发腰椎间盘突出。椎间盘突出类型与病变椎体和上位椎体的棘突的偏斜方向无明显关联。有该解剖变异者可以通过合理锻炼,加强脊柱稳定性,预防腰椎间盘突出。     

Gillet直接修补技术治疗腰椎椎弓峡部裂(2年随访结果)

目的探讨Gillet直接修补技术治疗腰椎椎弓峡部断裂的适应证和术后疗效。方法回顾性分析自2007-01—2011-12采用Gillet技术直接修补的双侧腰椎椎弓峡部断裂21例,行后路峡部断裂椎体双侧峡部瘢痕组织切除,椎弓根钉置入+峡部V形棒内固定+自体植骨融合术。结果术后21例均获得随访2~3年,平均2.5年。术前VAS评分(4.8±0.9)分,术后6周(2.1±0.6)分,术后24个月(2.3±0.7)分;术前ODI评分(52.6±8.9)%,术后6周(16.6±1.9)%,术后24个月(14.6±1.6)%。术后6周VAS评分(t=13.780,P0.001)、ODI评分(t=19.35,P0.001)较术前明显降低;术后24个月ODI评分(t=4.899,P0.001)较术后6周明显降低,差异均有统计学意义(P0.01)。术后6周VAS评分(t=0.940,P=0.358)与术后24个月比较差异无统计学意义(P0.01)。X线片及三维CT显示19个椎体植骨处在术后1年达到骨性愈合,未愈合患者症状也得到明显改善。结论对于腰椎椎弓峡部断裂患者,可以使用自体植骨+内固定直接修补峡部断裂处,避免后期腰椎滑脱的发生。     

Underlay mesh repair for spontaneous lumbar hernia

INTRODUCTIONLumbar hernia is a rare condition with fewer than 300 cases reported in the literature. It arises through posterolateral abdominal wall defects, named the inferior triangle (Petit) and superior triangle (Grynfelt). It can be congenital or acquired, primary or secondary, peritoneal or extraperitoneal, reducible or complicated.PRESENTATION OF CASEWe report a 63 year old female patient who presented to our hospital with a reducible right superior lumbar hernia. She underwent repair with underlay mesh after inversion of the sac and had a smooth postoperative course.DISCUSSIONIn contrast to the classical procedure the underlay mesh modification saved us from enlarging the defect, and was quick and associated with minimal tissue injury.CONCLUSIONUnderlay mesh repair for spontaneous lumbar hernia is feasible when the defect is small.     

髓核摘除Dynesys动态内固定系统固定治疗青壮年单节段腰椎间盘突出症的中长期疗效分析

【摘要】 目的：观察髓核摘除Dynesys动态内固定系统固定治疗青壮年单节段腰椎间盘突出症（lumbar disc heniation,LDH）的中长期疗效。方法：回顾性分析2010年12月～2014年8月于我院骨科手术治疗且资料完整的62例青壮年单节段LDH病患者的临床资料,其中31例采用髓核摘除Dynesys动态内固定系统固定术治疗（Dynesys组）,31例采用单纯髓核摘除术治疗（对照组）,两组患者的年龄、性别比、体重指数、病程、合并基础病、吸烟史、手术节段等基线数据无显著性差异。收集两组患者手术相关资料及并发症,比较两组术前及末次随访时的疼痛视觉模拟评分（visual analogue scale,VAS）、Oswestry功能障碍指数（Oswestry disability index,ODI）、手术节段和近端邻近节段的椎间盘高度（disc height,DH）、椎间活动度（range of motion,ROM）和椎间盘改良Pfirrmann分级。结果：对照组手术时间和术后住院时间更短、术中出血更少（P<0.05）。Dynesys组3例、对照组1例术中发现硬膜撕裂,予以仔细缝合修补,术后均未发生脑脊液漏;Dynesys组和对照组各有1例患者住院期间因发热使用抗生素治疗,均排除手术部位感染。对照组1例患者术后1个月因切口渗液、愈合不良再入院行清创术。Dynesys组随访72～109个月（91.8±11.1个月）;对照组随访72～116个月（93.7±12.7个月）。末次随访时两组患者腰痛和腿痛VAS评分、ODI均较术前显著性改善（P<0.05）,两组同时间点比较无显著性差异（P>0.05）;两组手术节段DH均较术前显著性下降（P<0.05）,对照组下降比Dynesys组更显著（P<0.05）;两组近端邻近节段DH较术前均无显著性变化。Dynesys组手术节段ROM在末次随访时得到部分保留（2.7°±2.1°）,但较术前显著性降低（P<0.05）;近端邻近节段ROM均较术前显著性增加（P<0.05）,但与对照组比较无显著性差异。末次随访时两组手术节段和近端邻近节段的椎间盘改良Pfirrmann分级均较术前进展（P<0.05）,对照组手术节段退变进展较Dynesys组更明显（P<0.05）。随访期间Dynesys组所有患者手术节段椎间盘突出均无复发,均未发现内固定断裂及松动并发症,无再手术病例,5例手术节段术前合并不稳患者均采用Dynesys动态固定系统固定,术后未再发节段不稳定;对照组3例患者因椎间盘突出复发且保守治疗无效行椎间融合术,1例患者因术后再发腰痛伴手术节段不稳,行椎间融合术。两组患者均未出现症状性邻近节段退变,总体并发症发生率无显著性差异（P>0.05）。结论：髓核摘除Dynesys动态固定系统固定治疗青壮年单节段腰椎间盘突出症安全有效,可减少复发并保留手术节段一定的活动度。     

Primary lumbar hernia: A rarely encountered hernia

IntroductionLumbar hernia is an uncommon abdominal wall hernia, making its diagnosis and management a challenge to the treating surgeon. Presentation may be misleading and diagnosis often missed. An imaging study forms an indispensable aid in the diagnosis and surgery is the only treatment option.Presentation of caseA 42 year old male presented with history of pain in lower back of 4 years duration and was being treated symptomatically over 4 years with analgesics and physiotherapy. He had noticed a swelling over the left side of his mid-back and consequently on examination was found to have a primary acquired lumbar hernia arising from the deep superior lumbar triangle of Grynfelt. Diagnosis was confirmed by Computed Tomographic imaging.DiscussionA lumbar hernia may be primary or secondary with only about 300 cases of primary lumbar hernia reported in literature. Lumbar hernias manifest through two possible defects in the posterior abdominal wall, the superior being more common. Management remains surgical with various techniques emerging over the years. The patient at our center underwent an open sublay mesh repair with excellent outcome.ConclusionA surgeon may encounter a primary lumbar hernia perhaps once in his lifetime making it an interesting surgical challenge. Sound anatomical knowledge and adequate imaging are indispensable. Inspite of advances in minimally invasive surgery, it cannot be universally applied to patients with lumbar hernia and management requires a more tailored approach.     

胸腰椎爆裂性骨折的影像学诊断与分类

目的 :进一步讨论胸腰椎爆裂性骨折的影像学诊断和分类。方法 :回顾性分析了 12 6例 13 9处胸腰椎爆裂性骨折 ,依据Atlas标准进行分类并比较其稳定性 ,对照了三种影像学诊断方法的优势及不足。结果 :Atlas分类A型 14例次 ,B型 79例次 ,C型 11例次 ,D型 19例次 ,E型 16例次。X线平片能发现大多数胸腰椎爆裂性骨折 ,但易漏诊、误诊 ;CT可准确显示椎体后缘、游离骨折片或椎间盘凸入椎管的程度 ;MRI能清晰显示韧带、椎间盘和脊髓变化。结论 :对怀疑或X线已诊断的胸腰椎骨折应常规作CT检查 ,MRI可作为判定脊髓损伤程度的补充。     

A morphological adaptation of the thoracic and lumbar vertebrae to lumbar hyperlordosis in young and adult females

The lumbar shape in females is thought to be unique, compensating for lumbar hyperlordosis. Yet, the morphological adaptation of various vertebral parameters in the thoracic and lumbar spine to this unique posture in young and adult females has only been partially addressed in the literature. Our aim was to investigate the gender association to vertebral shape in the thoracic and lumbar spine as a possible adaptation to lumbar hyperlordosis in young and adult females. A three-dimensional digitizer was used to measure the vertebral body sagittal wedging, relative spinous process thickness, and relative interfacet width at the T1–L5 level. Two hundred and forty complete, non-pathological skeletons of adults and 32 skeletons of young individuals were assessed. Three major results were found to be independent of age and ethnicity: (a) VB sagittal wedging in females was significantly less kyphotic than males from T9 to L2 (T11 excluded) with a cumulative mean difference of 8.8°; (b) females had a significantly relatively thinner lumbar spinous processes and (c) females had a relatively wider superior interfacet distance (T9–T10 and L1–L4) than males. We conclude that the combination of less kyphotic VB wedging in the lower thoracic and upper lumbar vertebrae, relatively greater interspinous space and larger interfacet width in the lumbar spine in females are key architectural elements in the lumbar hyperlordosis in females and may compensate for the bipedal obstetric load during pregnancy.     

Classification of thoracic and lumbar spine fractures: problems of reproducibility

Reproducibility of fracture classification systems in general has been a matter of controversy. The reproducibility of spinal fracture classifications has not been sufficiently studied. We studied the inter-observer and intra-observer reproducibility of the Magerl (AO) classification using radiograms, CTs and MRIs of 53 patients. We compared this classification with the older and simpler Denis classification. Five observers classified the fractures, first using the radiograms and CTs and, 6 weeks later, with radiograms and MRIs. Three of the observers repeated the readings after 3 months. Three observers also classified the fractures according to Denis. Agreement was measured using Cohen's kappa test. The type (A, B, C) classification of the AO system was fairly reproducible with CTs. With MRI this was only moderate. Group subclassification of the types yielded higher kappa values, corresponding to substantial agreement. The agreement was, in general, better with the Denis classification, but the variance was higher due to the difficulty of finding proper categories for some injury patterns. Although the AO classification allows proper registration of all kinds of injury, the reproducibility, especially at the type level, is problematic. Use of MRI and better definition of the distinctive properties of the three different types may enhance the reproducibility of the scheme.