【作者】 毕大卫； 徐建生； 费俊； 郑琦； 高根德； 童培健；

【Author】 BI Da-wei,XU Jian-sheng,FEI jun,er al.Orthopedic Department of Red Cross Hospital,Hangzhou 310003.

【机构】 杭州市红十字会医院骨科；

【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34例腰椎间盘突出和脊椎滑脱患者经后路椎管探查减压,椎间盘摘除,横突间融合,其中26例性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里临床分析。结果34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24例,尚可2例,良好率92.3%。结论由于脊椎瞬时旋转中心(instantaneous certer of rotaion,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。更多还原

【Abstract】 Objective:Apply mechanical tenet to explain the pathological relation ship between prolape of lumbar inrervertebral 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,through posterior way on 34 cases of prolapse of lunbar intervertebal disc combined with spondylolisthesis,then made clinical analysis on choice of operative from,operative principle and treat outcome.Results:According to Stanffer criterion of therapeutic effectiveness,the treatment group of fibular autotransplantation had 6 favovable cases,1common case and 1 disappointed case.Meanwhile,the treatment group of veterbral arch root screw reposition and internal fixation had 24favorable cases,2common cases and 92.3%favorable rate. Conclusion:Due to abnormal instantaneous center of rotation(ICR),the pathological disc and spondylolisthesis anr cause and effect.The goal of operation is not only to discomproess,fuse and fix,but also to keep vertebraos and to maitain the mechanical stability of vertbrac.Applying vertebral arch root screw to reduce dislocated vertebral body has important significance to this operation.更多还原