節段內椎弓根螺釘-椎板鉤系統固定治療腰椎峽部裂療效觀察_《中國修復重建外科雜志》

作者：

周忠杰 , 宋躍明 , 曾建成 , 劉浩 , 劉立岷 , 孔清泉 , 李濤 , 龔全

四川大學華西醫院骨科（成都，610041）;

關鍵詞：

腰椎峽部裂椎弓根螺釘-椎板鉤系統植骨修復

DOI：

10.7507/1002-1892.20130063

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目的探討經后路峽部植骨修復、椎弓根螺釘-椎板鉤系統固定治療腰椎峽部裂的療效。方法2005 年1月－2009年10月，采用經后路峽部植骨修復、椎弓根螺釘-椎板鉤系統固定治療22例腰椎峽部裂患者。男19例，女3例；年齡12～26 歲，平均18.4歲。主要臨床癥狀為腰痛。病程8～56個月，平均16個月。術前疼痛視覺模擬評分（VAS）為（6.0 ± 1.2）分，Oswestry功能障礙指數（ODI）為72.0% ± 10.0%。X線片示均為雙側峽部裂，病變節段：L4 9例，L5 13 例。病椎上、下椎間隙活動度分別為（11.8 ± 2.8）°及（14.1 ± 1.9）°。結果術后切口均Ⅰ期愈合。患者均獲隨訪，隨訪時間12～45個月，平均25個月。術后患者腰痛癥狀均明顯緩解，末次隨訪時VAS評分為（0.3 ± 0.5）分，ODI為17.6% ± 3.4%，與術前比較差異均有統計學意義（P lt; 0.05）。術后6個月CT示峽部缺損處植骨均融合，內固定物無松動、斷裂現象。末次隨訪時腰椎屈伸側位X線片示峽部裂修復后，其上、下椎間隙活動度分別為（12.3 ± 2.1）°及（13.5 ± 1.7）°，與術前比較差異無統計學意義（P gt; 0.05）。1 例術后出現髂骨取骨區疼痛，經對癥處理后癥狀消失。結論經后路峽部植骨修復、椎弓根螺釘-椎板鉤系統固定可有效治療腰椎峽部裂，植骨融合率高，并發癥少，最大限度保留了腰椎活動度。

引用本文： 周忠杰,宋躍明,曾建成,劉浩,劉立岷,孔清泉,李濤,龔全. 節段內椎弓根螺釘-椎板鉤系統固定治療腰椎峽部裂療效觀察. 中國修復重建外科雜志, 2013, 27(3): 274-277. doi: 10.7507/1002-1892.20130063 復制

1.	Ghiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg (Am), 2004, 86-A(7): 1497-1503.
2.	Fan J, Yu GR, Liu F, et al. A biomechanical study on the direct repair of spondylolysis by different techniques of fixation. Orthop Surg, 2010, 2(1): 46-51.
3.	Fan J, Yu GR, Liu F, et al. Direct repair of spondylolysis by TSRH’s hook plus screw fixation and bone grafting: biomechanical study and clinical report. Arch Orthop Trauma Surg, 2010, 130(2): 209-215.
4.	Radcliff KE, Kalantar SB, Reitman CA. Surgical management of spondylolysis and spondylolisthesis in athletes: indications and return to play. Curr Sports Med Rep, 2009, 8(1): 35-40.
5.	Giudici F, Minoia L, Archetti M, et al. Long-term results of the direct repair of spondylolisthesis. Eur Spine J, 2011, 20 Suppl 1: S115-120.
6.	Kim YT, Lee H, Lee CS, et al. Direct repair of the pars interarticularis defect in spondylolysis. J Spinal Disord Tech, 2012. [Epub ahead of print].
7.	Patel RD, Rosas HG, Steinmetz MP, et al. Repair of pars interarticularis defect utilizing a pedicle and laminar screw construct: a new technique based on anatomical and biomechanical analysis. J Neurosurg Spine, 2012, 17(1): 61-68.
8.	Tokuhashi Y, Matsuzaki H. Repair of defects in spondylolysis by segmental pedicular screw hook fixation. A preliminary report. Spine (Phila Pa 1976), 1996, 21(17): 2041-2045.
9.	Deguchi M, Rapoff AJ, Zdeblick TA. Biomechanical comparison of spondylolysis fixation techniques. Spine (Phila Pa 1976), 1999, 24(4): 328-333.
10.	Sairyo K, Sakai T, Yasui N. Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing. J Bone Joint Surg (Br), 2009, 91(2): 206-209.
11.	Dunn AJ, Campbell RS, Mayor PE, et al. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skeletal Radiol, 2008, 37(5): 443-450.
12.	Sakai T, Sairyo K, Suzue N, et al. Incidence and etiology of lumbar spondylolysis: review of the literature. J Orthop Sci, 2010, 15(3): 281-288.
13.	Mohi Eldin M. Minimal access direct spondylolysis repair using a pedicle screw-rod system: a case series. J Med Case Rep, 2012, 6(1): 396.
14.	Roca J, Iborra M, Cavanilles-Walker JM, et al. Direct repair of spondylolysis using a new pedicle screw hook fixation: clinical and CT-assessed study: an analysis of 19 patients. J Spinal Disord Tech, 2005, 18 Suppl: S82-89.
15.	Zhao J, Liu F, Shi HG, et al. Biomechanical and clinical study on screw hook fixation after direct repair of lumbar spondylolysis. Chin J Traumatol, 2006, 9(5): 288-292.
16.	Ulibarri JA, Anderson PA, Escarcega T, et al. Biomechanical and clinical evaluation of a novel technique for surgical repair of spondylolysis in adolescents. Spine (Phila Pa 1976), 2006, 31(18): 2067-2072.

1. Ghiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg (Am), 2004, 86-A(7): 1497-1503.
2. Fan J, Yu GR, Liu F, et al. A biomechanical study on the direct repair of spondylolysis by different techniques of fixation. Orthop Surg, 2010, 2(1): 46-51.
3. Fan J, Yu GR, Liu F, et al. Direct repair of spondylolysis by TSRH’s hook plus screw fixation and bone grafting: biomechanical study and clinical report. Arch Orthop Trauma Surg, 2010, 130(2): 209-215.
4. Radcliff KE, Kalantar SB, Reitman CA. Surgical management of spondylolysis and spondylolisthesis in athletes: indications and return to play. Curr Sports Med Rep, 2009, 8(1): 35-40.
5. Giudici F, Minoia L, Archetti M, et al. Long-term results of the direct repair of spondylolisthesis. Eur Spine J, 2011, 20 Suppl 1: S115-120.
6. Kim YT, Lee H, Lee CS, et al. Direct repair of the pars interarticularis defect in spondylolysis. J Spinal Disord Tech, 2012. [Epub ahead of print].
7. Patel RD, Rosas HG, Steinmetz MP, et al. Repair of pars interarticularis defect utilizing a pedicle and laminar screw construct: a new technique based on anatomical and biomechanical analysis. J Neurosurg Spine, 2012, 17(1): 61-68.
8. Tokuhashi Y, Matsuzaki H. Repair of defects in spondylolysis by segmental pedicular screw hook fixation. A preliminary report. Spine (Phila Pa 1976), 1996, 21(17): 2041-2045.
9. Deguchi M, Rapoff AJ, Zdeblick TA. Biomechanical comparison of spondylolysis fixation techniques. Spine (Phila Pa 1976), 1999, 24(4): 328-333.
10. Sairyo K, Sakai T, Yasui N. Conservative treatment of lumbar spondylolysis in childhood and adolescence: the radiological signs which predict healing. J Bone Joint Surg (Br), 2009, 91(2): 206-209.
11. Dunn AJ, Campbell RS, Mayor PE, et al. Radiological findings and healing patterns of incomplete stress fractures of the pars interarticularis. Skeletal Radiol, 2008, 37(5): 443-450.
12. Sakai T, Sairyo K, Suzue N, et al. Incidence and etiology of lumbar spondylolysis: review of the literature. J Orthop Sci, 2010, 15(3): 281-288.
13. Mohi Eldin M. Minimal access direct spondylolysis repair using a pedicle screw-rod system: a case series. J Med Case Rep, 2012, 6(1): 396.
14. Roca J, Iborra M, Cavanilles-Walker JM, et al. Direct repair of spondylolysis using a new pedicle screw hook fixation: clinical and CT-assessed study: an analysis of 19 patients. J Spinal Disord Tech, 2005, 18 Suppl: S82-89.
15. Zhao J, Liu F, Shi HG, et al. Biomechanical and clinical study on screw hook fixation after direct repair of lumbar spondylolysis. Chin J Traumatol, 2006, 9(5): 288-292.
16. Ulibarri JA, Anderson PA, Escarcega T, et al. Biomechanical and clinical evaluation of a novel technique for surgical repair of spondylolysis in adolescents. Spine (Phila Pa 1976), 2006, 31(18): 2067-2072.

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節段內椎弓根螺釘-椎板鉤系統固定治療腰椎峽部裂療效觀察

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節段內椎弓根螺釘-椎板鉤系統固定治療腰椎峽部裂療效觀察

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