椎弓根钉-椎板钩系统固定治疗单纯腰椎峡部裂

The surgical treatment of lumbar spondylolysis with a pedicle screw-lamina hook system

目的:观察应用椎弓根钉-椎板钩系统固定治疗单纯腰椎峡部裂的临床疗效。方法:自2002年6月以来,使用椎弓根钉-椎板钩系统治疗单纯腰椎峡部裂15例,均为男性,年龄19￣36岁,平均27岁。L46例,L59例,均为双侧病变。所有患者均主诉明确的腰痛,持续6个月以上。术前腰痛疼痛评分(VAS)7.8分。采用后正中入路,暴露双侧病灶,将峡部裂中的纤维瘢痕组织彻底清除,咬除骨残端硬化部分至出血为止,髂后上棘取骨行峡部裂局部植骨。安放病椎椎弓根螺钉及椎板钩,放置连杆后将固定系统锁紧。结果:术后疼痛症状明显缓解,VAS评分2.4分。随访12￣26个月,峡部裂植骨均骨性愈合,未见骨不连及内固定断裂。结论:对于年轻的、单纯峡部裂患者可以采用椎弓根钉-椎板钩系统进行峡部修复,避免脊柱融合术;椎弓根钉-椎板钩系统是一种安全、有效的内固定装置。

Objective：To observe tile elinieal results of a pediele screw-lamina hook system applied to treat the lumbar spondylolysis without spondylolisthesis.Method：Since June,2002,fifteen cases of lumbar spondylolysis without spondylolisthesis have been treated with a pedicle screw-lamina hook system.The mean age of the group was 27,from 19 to 36.Six eases of spondylolysis located at L4 and the other 9 at L5.All the patients suffered from severe back pain for more than six months.The average VAS before the operation was 7.8.During the operation,the presence of the pars interarticularis defect was confirmed.The defects were cleared of any tibrous and eartilaginous tissues.The sclerotic bone margins were curetted until bleeding was noted.Autograft havested from posterior ilium was done.The pediele screw-lamina hook system was placed onto the index vertebra.Result：All the patients were followed-up for more than 12 months （12-26 months）.The significant back pain relief was found in all the eases.The postoperative VAS was 2.4. The bony healing was comfinned in 12 cases,and the other 3 were in the process of bone growth.Conclusion：The simple spondylolysis in youth can be treated by the pediete screw-lamina hook system without spinal fusion.The pediele screw-lamina hook system is proved to be safe and effective.