摘要
[目的]总结多孔面螺钉单个椎体内固定治疗腰椎峡部裂脊椎滑脱的临床远期疗效,以及对固定椎邻近节段的影响。[方法]1991年1月～2011年1月,本院骨科采用多孔面螺钉经狭部固定治疗腰椎峡部裂脊柱滑脱患者217例,117例患者得到随访,平均随访8.2±7.8年。男90例,女27例;年龄16～61岁,平均(40.8±18.2)岁。所有病例均为双侧峡部裂,其中L3椎体峡部裂17例,L4椎体峡部裂31例,L5椎体峡部裂69例,无滑脱100例,伴Ⅰ°滑脱10例,Ⅱ°滑脱7例。所有病例采用神经根管减压,峡部硬化骨、瘢痕组织切除术+神经粘连松解+峡部植骨+多孔面螺钉内固定术。[结果]本组117例,手术时间(64.33±13.28)min,术中失血量(117.31±22.50)ml。随访时,112例症状完全消失,恢复术前工作,腰部活动不受限。Oswestry功能障碍指数由术前(28.37±3.99)减少至随访时(5.33±2.70),术前与随访时差异有统计学意义(P<0.01)。JOA评分由术前(19.00±2.78)增加至随访时(28.08±1.04),术前与随访时差异有统计学意义(P<0.01)。117例患者的治疗改善率90.34%。术后6个月后摄片复查均见峡部缺损处有骨小梁通过,峡部愈合率达99%,腰椎滑脱纠正率达80%。所有病例未出现螺钉松动及断裂现象,未发生邻近节段退变等并发症。[结论]多孔面螺钉设计符合生物力学特征,其材质符合人体生理特性,能永久植入体内。通过直接修复峡部断裂,重建脊柱单个运动单元的完整性,避免了松动、断钉以及邻近节段病的发生。
[Objective] To summarize the long- term clinical outcome of pars fixation with polyporous surface screws for lumbar spondylolysis, and explore its influence on the adjacent segments. [ Methods ] From Jan 1991 to Jan 2011,217 patients with lumbar spondylolysis were treated by pars fixation with polyporous surface screws in our hospital. Total 117 patients were fol- lowed up for an average of 8.2 ±7.8 years, including 90 male and 27 female patients, aged 16 - 91 years. All the patients suf- fered from bilateral lumbar spondylolysis, involving L3 in 17, L4 in 31, and L5 in 69 patients. Of the patients, 100 did not com- bined with spondylolisthesis, 10 combined with grade I and 7 with grade II of slipping. All the patients were treated surgically with decompression of nerve root, debridement of sclerous bone and scar tissue, neurolysis from adhesions, pars fixation with polyporous surface screws and isthmie bone grafting. [ Results] The operating time were （64. 33± 13.28） min, and volume of blood loss in operation were （117. 31 _＋22. 50） ml in average. At the latest follow up, 112 patients had returned to work without any symptoms and limited lumbar range of motion, conversely, only 5 patients had mild to moderate discomfort. Oswestry Disability Index decreased statistically from （28. 37 ±3.99） preoperatively to （5.33 ±2. 70） at the latest follow up （P 〈0. 01 ） . Improving rate of JOA score were 90. 34%. Continuous bone trabecnla passing the isthmic defect could be seen in X - ray film taken 6 months postoperatively. Additionally, 80% reduction of slipping, and 99% isthmie healing rate were achieved. Furthermore, no loosing or broken screws and adjacent segment disc degeneration were found. [ Conclusion] The design of the screws with pol- yporous surface is compatible with human biological and biomeehanical properties, can be implanted into the body permanently. This fixation method is able to rebuild the integrality of motion unit of spinal column by repairing the isthmus to prevent adjacent segment disc degeneration.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2012年第19期1733-1736,共4页
Orthopedic Journal of China
关键词
腰椎
脊椎滑脱
峡部裂
多孔面螺钉内固定
邻近节段病
lumbarpolyporous surface screw,diseasevertebrae, spondylolysis,pars fixation, adjacent segment
