腰椎峡部裂记忆合金节段内固定器的临床应用

目的：评价自行研制的腰椎峡部裂记忆合金节段内固定器(MAIF)的临床疗效。方法：采用峡部原位植骨记忆合金节段内固定术治疗23例腰椎峡部裂患者，术后软腰围固定3个月，23例患者均获随访，随访时间6个月～4年，疗效评定采用Henderson标准。结果：23例患者中，疗效为优的患者19例，3例疗效为良，1例疗效为一般，临床疗效优良率为95．65％；X线片示峡部愈合率为97．65％；随访中未发现并发症的发生。结论：MAIF是一种简便易行、固定可靠、疗效优良的治疗腰椎峡部裂的新方法。     

新型记忆合金节段内固定器治疗腰椎峡部裂的实验研究

目的 :设计一种治疗腰椎峡部裂的新型记忆合金节段内固定器 ,测试其材料力学特性 ,并评价其生物力学稳定性。方法 :测量 2 0具干燥完整成人腰椎标本获得数据 ,按数据采用镍钛记忆合金设计固定器并行材料力学测试。取 6具新鲜成人腰椎标本 ,先后形成正常脊柱组、峡部裂组、横突棘突钢丝捆绑组、钩螺钉固定组、Buck螺钉固定组、新研制记忆合金固定器固定组 6组实验模型。利用脊柱三维运动实验机 ,分别测试 6组的前屈 /后伸、左 /右侧弯及左 /右轴向旋转 6种运动的活动范围。结果 :材料力学测试表明其形态记忆功能良好 ,体温状态下会产生稳定可靠的回复力。 6组在前屈、后伸及左右旋转状态 ,峡部裂组稳定性最差 ,同其他 5组差别明显。而使用新研制记忆合金内固定器组可明显恢复腰椎稳定性 ,同正常脊柱组及其他 3种内固定组均无显著差别。另两种状态左右侧弯 6组均无显著性差别。结论 :新设计的内固定器符合腰椎的生物力学要求 ,较先前的半环状内固定器优势明显 ,具有很好应用前景     

腰椎峡部裂及椎体滑脱的手术治疗选择

目的研究腰椎峡部裂及椎体滑脱的手术治疗选择。方法对136例腰椎峡部裂及椎体滑脱患者分别采用改良Scott技术（Ⅰ组,95例）、后外侧融合坚强内固定（Ⅱ组,26例）和后路360。融合内固定（Ⅲ组,15例）治疗。单椎体节段融合73例,二节段融合53例,三节段融合10例。患者平均年龄35．6岁（15～66岁）。结果平均随访3．5年（2～11年）,临床疗效示优良率达91．2％,融合成功率为94．9％。结论满意的结果与严格的病例选择,准确、熟练的手术技术和合适的手术方法相关。对腰椎峡部裂及椎体滑脱患者行改良Scott技术、后外侧融合坚强内固定和360。融合内固定均能获得较好的影像学和临床结果。     

Buck法螺钉固定联合椎板-横突植骨术治疗腰椎椎弓峡部裂

目的 探讨Buck法螺钉固定联合椎板-横突植骨术治疗腰椎椎弓峡部裂合并轻度腰椎滑脱的手术效果。方法 应用Buck法螺钉同定联合椎板-横突植骨融合,治疗10例合并Ⅰ～Ⅱ度腰椎滑脱的腰椎椎弓峡部断裂。结果随访8个月～4年,均达骨性融合,腰痛等症状缓解。结论Buck法螺钉固定联合椎板-横突植骨融合技术治疗合并Ⅰ～Ⅱ度以内滑脱的腰椎椎弓峡部裂,手术创伤小,对腰椎生理影响小,疗效可靠。     

记忆合金固定器节段内固定治疗腰椎峡部裂的实验研究

目的：对自行研制的腰椎峡部裂单节段固定器械———节段记忆合金固定器（ＩＭＡＦ） 进行生物力学评价。方法：根据３０ 具成人干燥脊柱标本椎体测量结果,以镍钛合金为材料,设计ＩＭＡＦ;然后采用８ 具成人新鲜腰椎标本为实验材料,通过脊柱三维运动实验机,比较Ｂｕｃｋ 氏螺钉固定法、横突棘突钢丝捆绑法、钩螺钉固定法及ＩＭＡＦ 对峡部裂腰椎的固定作用。结果：４ 种方法均能显著地恢复脊柱的稳定性,且四者之间无显著性差别。结论：ＩＭＡＦ 是一种简便易行、固定可靠的新型节段内固定方法。     

椎弓根螺钉钢丝内固定治疗腰椎峡部崩裂

目的 介绍一种治疗腰椎峡部崩裂的方法。方法 用椎弓根螺钉钢丝捆绑加髂骨椎板植骨治疗滑脱小于50％且无神经根症状的腰椎峡部崩裂患者。结果 用椎弓根螺钉钢丝捆绑加髂骨椎板植骨治疗10例经半年随访全部骨性愈合。结论 椎弓根螺钉钢丝捆绑加髂骨椎板植骨为滑脱小于50％的腰椎峡部崩裂且无神经根症状患者提供了一种治疗选择。     

椎弓根螺钉张力带治疗腰椎峡部裂

目的评价椎弓根螺钉张力带治疗腰椎峡部裂的临床疗效.方法对25例峡部裂患者进行峡部修整、局部植骨、椎弓根螺钉张力带固定.结果2例失访,23例随访2～7年,平均随访3.5年.患者下腰痛等症状完全消失,未出现椎弓根螺钉及钢丝松动、断裂.复查腰椎X线片均提示峡部已骨性融合.结论椎弓根螺钉张力带是一种节段性内固定治疗腰椎峡部裂的方法,简单易行,疗效显著,其适应证较严格.     

改良Scott法治疗青年性腰椎椎弓崩裂

目的评价改良Scott法治疗青年性腰椎椎弓崩裂的临床疗效。方法对12例青年性腰椎椎弓崩裂患者进行峡部修理、植骨,而后行改良Scott法内固定。结果12例随访时间6-19个月,平均13个月。患者下腰痛或放射痛等症状显著缓解,按MacNab′s标准,优8例,良3例,一般1例,优良率为91.7%。未见椎弓根螺钉及钢丝松动、断裂,X线融合率为100%。结论改良Scott法是一种符合正常生理解剖的治疗青年性腰椎椎弓崩裂的方法,简单易行,疗效显著,但需掌握适应证。     

翼状记忆合金节段内固定器对犬腰椎峡部裂愈合的影响

[目的]探讨翼状记忆合金节段内固定器（WMAIF）对腰椎峡部裂愈合的影响。[方法]选取健康成年杂种犬18只，雌雄不限，均采取手术方法造成k双侧峡部崩裂的动物模型，随机分为3组，每组6只。Ⅰ组给予WMAIF内固定术，Ⅱ组给予横突棘突钢丝内固定术，Ⅲ组未采取内固定治疗措施。术后2、4、6、8、10周行CT扫描检查。[结果] CT扫描检查显示：Ⅰ组在术后6周峡部骨性融合，Ⅱ组在术后10周峡部骨性融合，Ⅲ组峡部未见骨性融合。[结论]WMAIF可对腰椎峡部裂起到有效的内固定和持续加压作用，使峡部愈合时间缩短，是一种新型实用的节段内固定器。     

加压螺钉内固定植骨治疗腰椎峡部裂（附14例报告）

本文介绍一种单脊椎内植骨内固定治疗腰椎峡部裂的手术方法。手术直接在峡部裂外修整植骨，并采和通过峡部裂间隙的加压螺钉作内固定，旨在恢复椎弓连续。本组病例１４例，均获得随访，Ｘ线复查显示植骨愈合１３例，按Ｈｅｎｄｅｒｓｏｎ标准评价，临床优良率达９２．８％。     

腰椎峡部裂翼状记忆合金节段内固定器的研制

目的研制治疗腰椎峡部裂的新型记忆合金节段内固定器,测试其材料力学特性,并进行有限元分析和生物力学稳定性评价。方法依据干燥完整的成人腰椎标本相关解剖数据的测量结果,利用镍钛记忆合金良好的形状记忆功能和独特的生物力学特征设计一种整体型翼状腰椎峡部裂记忆合金节段内固定器,并进行材料力学测试和有限元分析。应用脊柱三维运动实验机进行生物力学测试。结果材料力学测试及有限元分析表明其形态记忆功能良好,体温状态下能产生稳定可靠的回复力,且应力分布均匀,抗拉能力强,具有弹性固定作用。峡部裂腰椎6种运动状态时的生物力学稳定性均明显下降,而应用翼状记忆合金节段内固定器可明显恢复其稳定性。结论新型翼状记忆合金节段内固定器符合腰椎解剖结构特征,设计合理,抗拉能力强,应力分布均匀,能使腰椎峡部裂达到具有弹性的坚强节段内固定。     

钉-钩单椎体内固定+峡部植骨治疗青年腰椎峡部裂

目的评价单椎体内固定＋峡部植骨融合治疗腰椎峡部裂的临床疗效。方法对24例慢性腰痛（或）神经根症状的腰椎峡部裂（无脊柱滑脱）患者,采用单椎体内固定、峡部修整、峡部植骨融合治疗。结果24例均随访2年。患者下腰痛症状完全消失,未出现内固定系统的松动、断裂。X线及CT片均提示峡部已骨性融合。结论单椎体内固定＋峡部间植骨融合是一种治疗腰椎峡部裂简便、有效的方法。     

椎板回植椎弓根钉系统一体化固定治疗腰椎滑脱伴神经损伤

目的探讨采用椎板回植与椎弓根钉系统一体化固定腰椎滑脱合并神经损伤手术中的疗效。方法应用椎板回植与椎弓根钉系统一体化固定技术治疗腰椎滑脱合并神经损伤53例,L3~4滑脱4例,L4~5滑脱29例,L5~S1滑脱20例,退行性滑脱37例,单节段峡部崩裂性滑脱16例。结果53例均随访3年以上(3年8个月~7年2个月),全部病例回植椎板均在术后3~4个月达到良好的骨性融合,无对神经产生新的压迫,无症状复发和腰椎滑脱加重。结论椎板回植与椎弓根钉系统一体化固定在治疗腰椎滑脱合并神经损伤应用中操作简单、安全、可靠,具有恢复局部结构和维持脊柱稳定性的特点。     

采用临时短节段椎弓根螺钉固定联合髂骨植骨治疗青少年腰椎椎弓崩裂症的临床观察

目的观察并评价临时短节段椎弓根螺钉固定联合髂骨植骨治疗青少年腰椎椎弓崩裂症的临床疗效。方法回顾性分析2016年8月至2018年12月因腰椎峡部崩裂症42例患者,对30例平均年龄为24.4岁符合标准的患者采取本手术方法。采用全椎弓根螺钉固定联合横连装置进行崩裂的峡部椎体和下位椎体进行坚强固定。对崩裂的峡部进行瘢痕清理和硬化骨处理;最后取自体髂骨进行峡部修补。术后定期随访,待峡部植骨融合后再次给予内固定取出,恢复固定节段活动度。行X线及CT检查,确定其峡部骨性愈合。待峡部融合后再次取出内固定装置,恢复固定节段活动,进行腰椎动力位片检查评估,测量固定节段的活动度,与术前同节段活动度进行对比。同时分别在手术前、手术固定1年时及内固定取出后1年行腰椎MRI检查,并采用modic分级及pfirrmann分级标准来观察固定节段椎间盘及椎体终板的变化,观察固定节段相应椎体的终板及椎间盘的变化。结果完整随访30例,平均随访时间24(18~36)个月;平均手术时间为107 min;平均出血量为126 ml;平均融合时间为13个月;融合率为100%。所有患者原有下腰痛症状消失,所有患者X线及CT片均提示峡部融合。内固定装置取出后,对患者进行腰椎过伸过屈位X线片检查,动力位片显示固定阶段活动度保存良好,活动度保留率为88.5%。腰椎MRI显示,16例患者固定阶段终板modic改变呈正变化,14例患者无变化,固定阶段椎间盘组织无明显退变变化。结论临时短节段椎弓根螺钉联合横连装置固定是一种治疗腰椎峡部裂简便、有效的方法,固定坚强、融合率高;且临时短节段坚强固定并不会加速固定节段椎间盘退变及临近节段的退变。     

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.     

单节段峡部植骨固定治疗腰椎峡部不连的临床分析

目的: 研究单节段峡部植骨固定治疗单纯峡部不连的手术方法及应用价值。方法: 46例单纯峡部不连病人, 采用椎弓根螺钉、椎板钩加峡部植骨固定治疗, 术后进行随访,探讨此手术方式的峡部不连愈合及病人症状改善、运动及工作能力恢复情况。结果: 本组 46例病人经平均 16个月随访, 下腰部疼痛及下肢放射痛明显缓解, 峡部不连愈合, 生理功能恢复良好, 优良率达 93. 5%, 没有刀口感染、内固定物断裂、神经根损伤等并发症。结论: 单节段峡部植骨椎板钩固定是治疗腰椎峡部不连的一种简单有效的方式。     

Direct repair of multiple levels lumbar spondylolysis by pedicle screw laminar hook and bone grafting: clinical, CT, and MRI-assessed study

INTRODUCTION: A prospective analysis of 6 cases with multiple-level spondylolysis treated by direct repair with pedicle screw laminar hook is presented. The objective of the study was to evaluate the clinical outcome, plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging to demonstrate the result of direct repair in the treatment of multiple-level spondylolysis. MATERIALS AND METHODS: Ten patients with multiple-level spondylolysis of lumbar spine were treated with segmental pedicle screw hook fixation and autogenous bone graft. Four patients had lost follow-up. Six patients were followed up for a minimum of 2 years (mean 34.3 mo, range 24 to 55 mo). Patient's average age was 22 years old (range from 20 to 25 y old). All lytic defects were bilateral and located at 2 different lumbar vertebras (levels). CT scans and MR images were obtained at the latest follow-up postoperatively to assess the healing of the bony defects and the adjacent disc conditions. Fusion was considered to be presented when trabecula across the lytic defect was detected. RESULTS: The union rate was 87% (21 pars/24 pars) on plain radiographs and 75% (18 pars/24 pars) on CT scans. Follow-up magnetic resonance imaging of lumbar spine showed no disc degeneration. All patients were satisfied (either excellent or good) with the postoperative outcomes. CONCLUSIONS: Direct repair of multiple-level spondylolysis by pedicle screw laminar hook and autogenous bone graft would be the alternative of treating patients with persistent back pain after 6 months of conservative treatment The favorable clinical outcome was correlated with bony healing rate in this series.     

Tension band wiring-bone grafting for spondylolysis and spondylolisthesis. A clinical and biomechanical study

Patients with spondylolysis or spondylolisthesis with persistent symptoms often require surgical treatment. The purpose of this article is to present a new surgical technique and clinical results of 13 patients with symptomatic spondylolysis/spondylolisthesis who were treated with tension band wiring (intra- or intersegmental) and bone grafting techniques. This article also presents the results of biomechanical effects of these tension band wiring methods on canine lumbar spines with experimental spondylolytic defects. Thirteen adult patients, three with spondylolysis, and ten with spondylolytic spondylolisthesis, were treated with intrasegmental or intersegmental wiring with bone grafting technique, and the clinical results were evaluated at the mean follow-up period of 20 months. Patients with spondylolysis were treated with intrasegmental wiring (transverse processes to the spinous process of the same segment) with bone grafting at the lytic defect. Patients with spondylolytic spondylolisthesis were treated with intersegmental wiring (transverse process of the segment with defect to the spinous process of the same segment and to the spinous process of the segment below) with bone grafting to the defect and one-level fusion. All 13 patients had a solid spinal fusion and/or healing of the defect at the follow-up evaluation. Eleven had excellent clinical results; one a good, and one a fair result. The results of the biomechanical study showed that the experimental spondylolytic defect produced a significant decrease in bending stiffness (flexion-extension), and the wiring techniques (both the intra- and intersegment) increased the bending stiffness to that of the normal intact spinal segment.     

钉棒系统固定结合峡部植骨融合治疗青少年腰椎峡部裂远期疗效

目的：探讨腰椎后路椎弓根钉固定结合峡部植骨融合治疗青年腰椎峡部裂远期疗效。

方法：回顾性分析自2006年1月至2014年7月收治16例采用腰椎后路椎弓根钉固定结合峡部植骨融合术治疗的单纯腰椎峡部裂不伴有腰椎滑脱的青年患者,其中男11例,女5例;年龄18~21岁,平均19.3岁;病程12~26个月,平均22个月。所有患者存在活动后腰部疼痛,严重者下床活动困难,术前CT证实L₅峡部裂12例,L₄峡部裂4例,并在术后影像学证实植骨融合后取出内固定。采用腰痛视觉模拟评分法对术前、术后各时间点进行评分,采用腰椎CT检查评估腰椎峡部融合情况,采用腰椎MRI检查评估固定节段及邻近节段腰椎间盘退变情况。

结果：本组16例患者,13例26侧获得完整随访,平均96个月;手术时间80~105 min,平均95 min;术中出血量150~300 ml,平均225 ml。所有患者手术顺利完成,无手术相关并发症发生;患者术后各时间点VAS评分较术前改善（P<0.01）。术后腰椎CT检查均获骨性融合,融合时间6~14个月,平均12个月;腰椎MRI检查无邻近节段退变及固定节段间盘变性、突出等改变,术后远期无症状复发及再发峡部裂。

结论：采用腰椎后路椎弓根钉固定结合峡部植骨融合治疗青年腰椎峡部裂,该术式安全、有效,融合率高,减少对正常生理活动范围的干扰,长期疗效满意。