重度脊椎滑脱的手术治疗

A Modificd Dick System for Reduction ofSpondylolisthesis

根据对４０具国人下胸椎及腰椎椎弓根形态的测量结果，作者对ＤＩＣＫ器械进行了改良设计，在保留原有器械纵向承开功能的基础上，通过增加的悬吊钩固定复位螺钉，并以此为支点行牵拉复位，同时增大了复位螺纹进入椎体部分的螺纹直径，以提高螺钉的抗拔出力。临床应用２０例重度腰椎滑脱患者，术前平均滑脱率４８．３％（３２．６％～６２．５％）。经过一次手术者８例，三次手术者１例。术后椎体平均复位率８０．８％（６０～１００％）。配合腰背支具可早期下床活动。

Abstract For the patients with severe spondy-lolisthesis,the major goals for an ideal sur-gical treatment are decompression of neuro-logical compromise,reduction of sliding ver-tebra and solid spinal fusion. The presentproblem is the unsatisfactory reduction.Toimpove the reduction results,on the basis ofDick system,we designed a new reductionsystem characterized as followings,1 )withits distraction function remained,2)aneasily installed suspending hook used tosupport the reduction screw and as a ful-crum of reduction force,3)a modified re-duction screw including an insertion partwith a threadof 8 mm.in diameter and 40mm. in length. The design was based on ourprevious cadaver study on vertebral mor-phometry which showed that the width ofL3 pedicle is narrowest and the length of L5pedicle shortest.Our reduction screw issuitable for the narrowest and shortest pedi-cles with maximal resistance to pull-outforce with its insertion part totally driveclinto the vertebral body. Twenty patientswith spondylolisthesis of more than Ⅱ° havebeen treated with our reduction system withan average reduction rate of 80.8%(60%-100%)and no neurological complicationpresented.