摘要
目的 :用力学原理解释腰椎间盘突出症和脊椎滑脱的病理关系 ,以指导手术方法。方法 :自 1990年 1月～1997年 12月共 3 4例腰椎间盘突出和脊椎滑脱患者经后路行椎管探查减压 ,椎间盘摘除 ,横突间融合 ,其中 2 6例行RF或Steffee椎弓根螺钉复位内固定术 ,8例采用自体腓骨纵截移植脊椎融合内固定术 ,对术式选择、手术原则和治疗结果进行了临床分析。结果 :3 4例手术患者按Stauffer疗效标准 ,自体腓骨移植治疗组 ,良好 6例 ,尚可 1例 ,差 1例 ;椎弓根螺钉治疗组良好 2 4例 ,尚可 2例 ,良好率达 92 .3 %。结论 :由于脊椎瞬时旋转中心 (instantaneouscenterofrotaion ,ICR)应力点的异常 ,腰椎间盘突出症和脊椎滑脱在病理上是互为因果的 ,手术目的不但是减压融合固定 ,更重要的是保持ICR的正常应力范围 ,以减少脊椎前滑力 ,维持脊椎的力学稳定性。应用椎弓根螺钉复位滑脱的椎体对本手术有重要的意义。
Objective: Apply mechanical tenet to explain the pathological relation ship between prolapse of lumbar intervertebral disc and spondy lolisthesis, then to guide operative principle. Methods: From Jan. 1990 to Dec. 1997, we applied decompression and exploratory operation of spinal canal, removal of vertebral disc, fusion of transverse process and either RF, Steffee reposition and internal fixation with vertebral arch root screw of another with fibular transplantation and internal fixation through posterior way on 34 cases of prolapse of lumbar intervertebral disc combined with spondylolisthesis, then made clinical analysis on choice of operative form, operative principle and treatment outcome. Results: According to Stanffer criterion of therapeutic effectiveness, the treatment group of fibular autotransplantation had 6 favorable cases, 1 common case and 1 disappointed case. Meanwhile, the treatment group of veterbral arch root screw reposition and internal fixation had 24 favorable cases, 2 common cases and 92.3% favorable rate. Conclusion: Due to abnormal instantaneous center of rotation(ICR), the pathological disc and spondylolisthesis are cause and effect. The goal of operation is not only to discompress, fuse and fix, but also to keep the normal stress spot range of ICR, which is more important than the former, then to diserense the anterior sliding power of vertebraos and to maitain the mechanical stability of vertebrac. Applying vertebral arch root screw to reduce dislocated vertebral body has important significance to this operation.
出处
《中国矫形外科杂志》
CAS
CSCD
2000年第2期129-131,共3页
Orthopedic Journal of China
关键词
腰椎间盘突出症
脊椎滑脱
生物力学
手术外科
Prolapse of lumbar intervertebral dise Spondylolisthesis Biomechanics Operation
