峡部植骨修复拉力螺钉张力带固定治疗青少年下腰椎峡部裂

目的　探讨青少年下腰椎峡部裂的治疗中直接峡部植骨修复拉力螺钉张力带固定手术方法及其价值。　方法　共 12例 ,年龄范围 12 0～ 2 6 0岁 ,平均 18 4岁。术中暴露峡部并清理缺损区的纤维组织 ,分别切除两侧 1 0～ 2 0mm骨质 ,暴露新鲜骨界面 ,间隙内植入髂骨块 ,以椎板下缘中线旁开 8mm为进钉点 ,向头端和外侧各 30°倾斜安装长度 35 0～ 4 5 0mm ,直径 3 5mm钛质拉力螺钉 ,穿越峡部缺损和植骨块直至穿透椎弓根的外上缘皮质并紧固。峡部缺损表面植入条状植骨条 ,采用高强度尼龙线在螺钉尾部和横突基底部间形成张力带结构 ,关闭切口并留置负压引流。手术后石膏腰围固定 2个月。　结果　手术平均时间为 (10± 5 5 )min ,失血量为 170ml,术后随访 12～ 36个月 ,平均 17个月 ,所有修复的 2 2个峡部均在术后 3个月愈合。　结论　峡部植骨修复拉力螺钉张力带固定治疗青少年下腰椎峡部裂是一种简单、安全、可靠的术式 ,结合了生物力学和生物学过程 ,具有创伤小和保留病变节段运动功能的优点。

Bone graft repair of adolescence spondylolysis with lag screw and tension band fixation

OBJECTIVE: To investigate direct bone graft repair with lag screw and tension band fixation technique and its value for the treatment of adolescence spondylolysis. METHODS: Lysis was prepared and the fibrous tissue within the gap was removed in 12 patients from 12 to 26 years (average 18.4). 1 - 2 mm extra bony element was resected on both sides with fresh interface with the bone graft harvested from the iliac crest. From the entry point 8 mm away from the midline at the inferior margin of the lamina, titanium lag screws of 35 - 45 mm long and 3.5 mm in diameter were placed at 300 upward and outward and tighted through the lysis, bone graft and the superior and lateral aspect of the pedicle. Extra match bone graft was placed around the surface of defect, an high intensity Nilon wire tension band between the cap of the screw and the basis of transverse process was constructed before wound closure and suction drainage. The patients were immobilized with plaster brace of Paris for 2 months. RESULTS: Average operation time was (10 +/- 55) minutes, and average blood loss was 170 ml. Follow-up ranged from 12 to 36 months (mean 17 months), and cases of 22 lysis healed within 3 months. CONCLUSIONS: Technique of direct bone graft repair with lag screw and tension band fixation for the treatment of adolescence spondylolysis is simple, safe and reliable. Combined biomechanical and biological processes, it is less invasive but advantageous in preserving the motion in the affected segment.