腰椎间盘突出症与脊椎滑脱的力学分析和手术治疗

目的用生物力学原理分析椎间盘突出症和脊椎滑脱的病理关系，探讨经后路减压、椎间盘摘除、椎弓根钉固定、椎间体融合的手术方法。方法52例腰椎间盘突出症和脊椎滑脱患者均有腰痛或同时伴有坐骨神经痛，全部采用后路行半椎板或全椎板切除探查减压、椎间盘摘除、椎间植骨融合、后路短节段椎弓根钉复位内固定术，对手术方法原则和治疗结果进行临床分析。结果52例手术患者中按Stamffer疗效标准，良好48例，尚可4例，良好率达92．3％。结论由于脊椎瞬时旋转中心（instantaneous center of rotation，ICR）应力点的异常，腰椎间盘突出症和脊椎滑脱在病理上是互为因果的。该手术治疗保持了ICR的正常应力范围，减少了脊椎前滑力，维持了脊柱各方向近期和远期的力学稳定性。

The mechanical analysis and treatment of lumbar disc herniation and spondylolisthesis

Objective To apply mechanical tenet to explain the pathological relationship between prolapse of lumbar intervertebral disc and spondy lolisthesis,and explore the surgical methods of the posterior decompression,inter-extraction,pedicle screw fixation and intercentrum interbody fusion.Methods Totally 52 cases of prolapse of lumbar intervertebral disc and spondy lolisthesis patients are associated with lumbago or sciatica at the same time.All were treated by the surgical method that posterior whole or half laminectomy exploration decompression,discectomy,intervertebral fusion and the short segment posterior pedicle screw reduction and internal fixation,made clinical analysis on choice of operative form,operative principle and treatment outcome.Results According to Stamffer criterion of therapeutic effectiveness,of which 48 patients were favorable cases(92.3%) and 4 common cases.Conclusion Due to abnormal instantaneous center of rotation(ICR),the pathological disc and spondylolisthesis are cause and effect.The operation keep the normal stress-spot range of ICR,which is more important than the former,then to diserense the anterior sliding power of vertebraos and to maitain the mechanical stability of vertebrac.