摘要
目的 评价腰椎弓崩裂直接修复后采用椎板钩-椎弓根钉固定的生物力学作用，并探讨其应用于青年患者的临床价值。方法选用8具新鲜小牛腰椎标本，于L4制作椎弓崩裂模型，按正常标本组、峡部裂组、改良Scott固定组、钩钉固定组和Buck螺钉固定组顺序分别测量腰椎不同运动状态下的稳定性。2002年7月-2004年2月，14例男性单纯腰椎弓崩裂患者（15～31岁）接受自体骨直接修复峡部裂后椎板钩、椎弓根钉固定术，随访并根据影像学结果及MacNab标准进行临床评价。结果3种内固定方式均能有效恢复腰椎稳定性，钩钉法在抗旋转不稳方面更优于Buck钉及改良Scott法，同时钩钉法和Buck钉固定法在提高屈曲稳定性方面优于改良Scott法。临床病例无手术及内固定相关的并发症发生，平均随访21个月，除1例术后单侧椎弓崩裂处不融合外，其余患者均获得植骨愈合。按MacNab标准：优、良13例，一般1例。结论椎板钩一椎弓根钉应用于青年性腰椎弓崩裂直接修复后固定可在减少融合节段的同时能有效恢复腰椎稳定；临床应用简便、安全、有效。
Objective To evaluate the biomechanical performance and clinical results of hook plus screw fixation after direct repair of lumbar spondylolytic defects in the pars interarticularis. Methods Eight fresh-frozen and thawed calf cadaveric lumbar L2-L6 spines were used for mechanical testing. The bilateral spondylolytic defects were created in the IA vertebra. The intervertebral rotation （ IA and L5） were scanned and computerized when flexion/extension, lateral bending and torsion loading were applied on the intact spine, spondylolytic spine and spondylolytic spine fixed by modified Scott＇s fixation, hook plus screw fixation and Buck＇ s fixation sequentially and respectively. From July 2002 to February 2004, 14 young male cases suffered from symptomatic lumbar spondylolysis were selected to be treated with hook screw fixation after direct repair of the defect. MacNab criteria were used to assess their pre- and post-operative status. Results Each fixation technique significandy increased stiffness and returned the intervertebral rotational stiffness nearly to intact levels. Hook plus screw technique provided more rotational stability than the other two techiniques. Hook plus screw and Buck＇ s technique also could provide more flexion/extension stability than the modified Scott＇ s technique. Neither complications nor instrumentation failure were observed. The follow up for mean 21 months showed good or excellent results in 13 cases according to MacNab criteria but unilateral nonunion in one. Conclusion Hook plus screw fixation can reduce fusion segments and recover stability of the lumbar vertebrae and is simple, safe and effective clinically.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2006年第5期348-352,共5页
Chinese Journal of Trauma
基金
江苏省135重点人才基金资助项目(RC2003101)
关键词
腰椎
脊柱骨折
骨折
应力性
骨折固定术
内
生物力学
Lumbar vertebrae
Spinal fractures
Fractures, stress
Fracture fixation, internal
Biomechanics
