强力圈联合椎弓根钉治疗腰椎滑脱的疗效观察

Therapeutic Effect of the Surgical treatment of Sopndylolisthesis with the Combined use of Reinforced Ring and Pedical Nails

目的 探讨应用强力固定圈联合椎弓根钉治疗腰椎滑脱的优越性，为应用此方法提供理论依据。方法 应用自行设计的强力固定圈联合治疗腰椎滑脱30例，一侧椎弓峡部不连11例，双侧峡部不连19例，Ⅰ°滑脱18例，Ⅱ°滑脱10例，Ⅲ°2例。采用直视下操作，在滑脱椎体打入双螺纹提拉钉，并在椎板上放置强力固定圈后用悬吊钩连接，然后上紧双螺纹拉钉的螺母，使滑脱的椎体靠其提拉作用复位，最后后路椎间和关节突及横突周围植骨。结果 术后均随访半年以上。18例Ⅰ°滑脱基本达到解剖复位，10例Ⅱ°滑脱中5例达到解剖复住，5例基本复位，2例Ⅲ°滑脱者，1例解剖复位差，Ⅰ例部分复住。28例Ⅰ°和Ⅱ°滑脱患者症状完全消失，无复发，解剖复位率90．3％，且植骨全部融合。结论 本方法的使用减少了椎弓根钉的使用数量，克服了椎弓根钉进钉点受器械限制的缺点，缩短了手术时间，并且固定可靠，复位率高，操作简单，易于推广。

Objective To study te effectiveess of the surgical treatment of spendylohsthesis with the combined use of a self- desingned device consisting of the reinforced ring under the lamina, pedical nail for the reduction and provide the proof for using rids apparatus. Methods 30 cases of spendylolishthesis were traated with this method. One side vertebral arch broken is 11 cases, both sides is 19 cases. The pedical nail into centrum though verebral arch, then put the reinforced ring in which have a hook for connecting to the pedical nail on the vertebral plate, the sopendylolishesis would reestablish though the funcitoon of the pedical nail. At last, bone graft was done around the facets and the transverse processes. Results The follow - up period extended for more than half one year. All 18 cases of Ⅰ degree get anatomical reestablishment,5 cases get anatomical reestablishment and 5 cases get foundational reestablishment in 10 cases of Ⅱ degree,one get worse reestablishment and another get partial reestablishment in 2 cases of Ⅲ degree. The symptom of 28 patients of Ⅰ and Ⅱ degree all disappeared and no recrudescence. Anatomical reduction was attained in 90.3 % of the cases with healing of the bone graft in all. Condusion The application of this method avoided intra- operative loosening of the pedicle nails;the number of pedicle nails used could be reduced; the sites of nails intsertion were selected without the restrictions by instrumentation;the opeml6on period was shortened; reliable fixation and high achievement ratio; easy to operation and generalization.