椎弓根螺丝钉、棘突钢丝系统治疗青年性腰椎椎弓峡部裂

Clinical application of pedicle screw and spinous process steel-wire fixation after isthmic bone grafting in young patient with lumbar spondylolysis

目的探讨自体髂骨峡部植骨后椎弓根螺丝钉、棘突钢丝系统治疗青年性单纯峡部裂的疗效。方法 2006年7月-2011年3月,对23例共46处男性单纯青年性腰椎椎弓峡部裂患者(19～28岁)行腰椎弓峡部裂取自体髂骨直接修复峡部裂后,行椎弓根螺丝钉、棘突钢丝内固定。术后随访,根据术后X线、CT结果评价修复效果,并根据MacNab’S标准进行临床评价。结果随访6～56个月,平均31个月。X线片及CT三维重建提示所有病例均获得骨性融合,融合率为100%;临床下腰痛显著缓解,按MacNab’s标准,优17例,良4例,一般2例,优良率为91.3%;术中硬脊膜损伤1例,并发症发生率为4.3%。结论峡部植骨修复后椎弓根螺丝钉、棘突钢丝系统固定治疗青年性腰椎椎弓峡部裂符合生物力学原则,能充分保留腰椎运动节段,避免椎间融合的同时能有效恢复腰椎稳定,操作简便、安全,固定可靠,疗效显著,并发症少,是治疗单纯腰椎椎弓峡部裂的理想方法。

Objective To introduce an operative technique for spondylolysis of bone graftging in the isthmic defect and application of pedicle screw and spinous process steel-wire fixation in young patients.Methods From July 2006 to March 2011,23 young male patients who sufered from lumbarspondylolysis were selected to be treated with pedicle screw and spinous process steel-wire fixation after direct repair of the defect.MacNab′S criteria was used to assess their pre-and postoperative status.Results The average period of followed-up were 31months（6~56 months）.Radiographs showed all patients having bilateral union.All patients with low back pain or radicular pain experienced significantly relieved,17 patients were graded in excellent,and 4 good,and 2 common.The excellent rate was 91.3%,one cases of spinal injury patients,the complication rate was 4.3%.Conclusion Bone graft after the isthmus of the pedicle screw and interspinous wiring fixation for the treatment of young lumbar spondylolysis isthmus split in line with the principles of biomechanics,it retained the lumbar motion segment fully,to avoid interbody fusion at the same time can effectively restore the lumbar spine stable.This biomechnical operation is technically simple,operate security,reliable fixed,the curative effect is significant and less complications,so it was the ideal method for the treatment of lumbar spondylolysis in young patients.