天津医药

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钉-钩系统峡部重建术治疗单纯腰椎峡不连

郝永宏1,邓树才2,吉宁3,李建江4   

  1. 1. 天津市天津医院
    2. 天津医院脊柱外科
    3. 天津医院
    4.
  • 收稿日期:2010-01-05 修回日期:2010-03-22 出版日期:2010-10-15 发布日期:2010-10-15
  • 通讯作者: 郝永宏

Direct repair of defect in lumbar spondylolysis with a pedicle screw- lamina hook system

  • Received:2010-01-05 Revised:2010-03-22 Published:2010-10-15 Online:2010-10-15
  • Contact: Hao Yong Hong

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摘要： 【摘要】目的: 评价钉-钩系统峡部重建术治疗单纯腰椎峡不连的临床疗效。方法：自2005年8月以来，应用钉-钩系统峡部重建术治疗单纯腰椎峡不连10例， 其中男性8例，女性2例，年龄18～26 岁，平均22岁。L22例, L3 1例, L43例，L54例均为双侧峡不连。所有患者均主诉明确的腰痛, 持续6 个月以上，且保守治疗无效。术前腰痛疼痛评分(VAS) 7.2 分。采用常规后正中切口，清楚显露相应节段的椎板、峡部及椎弓根进钉点，并确定病椎。置入椎弓根钉，切除峡部断端的硬化骨及瘢痕，用磨钻打磨峡部断端至出血为止，做好植骨床，于自身髂后上棘取松质骨并制成骨泥植入峡部植骨床，安放病椎椎板钩, 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2.2 分，平均随访18个月，通过术后X－ray和CT 评估峡部融合情况，融合率为100%，平均融合时间为6.5个月。随访12～36个月, 峡不连处植骨均骨性愈合, 未见骨不连及内固定断裂。结论: 对于年轻的、单纯腰椎峡不连患者可以采用钉-钩系统峡部重建术进行治疗，可避免脊柱融合术，且操作简便，创伤小，可使腰椎峡部断端达到很高的融合率。

关键词: 腰椎, 峡不连, 峡部重建术

Abstract: 【Abstract】Objective: To observe the clinical results of a pedicle screw- lamina hook system applied to treat the lumbar spondylolysis without spondylolisthesis.Method: Since august, 2005, 10 cases of lumbar spondylolysis without spondylolisthesis have been treated with a pedicle screw- lamina hook system.Eight cases is male,tow cases is female.The mean age of the group was 22, from 18to 26.Tow cases of spondylolysis located at L2,one case at L3,three cases at L4,four cases at L5.All the patients suffered from severe back pain for more than six months.The average VAS before the operation was 7.2.During the operation, the presence of the pars interarticularis defect was confirmed.The defects were cleared of any fibrous and cartilaginous tissues.The sclerotic bone margins were curetted until bleeding was noted.Autograft havested from posterior ilium was done.The pedicle screw- lamina hook system was placed onto the index vertebra.Result: All the patients were followed- up for more than 18 months ( 12～36months) .The significant back pain relief was found in all the cases.The postoperative VAS was 2.2. The bony healing was comfirmed in 10 cases.Conclusion: The simple spondylolysis in youth can be treated by the pedicle screw- lamina hook system without spinal fusion.The pedicle screw- laminahook system is proved to be safe and effective.

Key words: Lumbar spine, Spondylolysis, Repair of lumbar spondylolysis