改良Scott法治疗12例青年性腰椎弓崩裂的生物力学变化评价  

Biomechanical changes of modified Scott wiring fixation in treating 12 young patients with lumbar spondylolysis

作　　者：樊健[1] 俞光荣[1] 刘璠[2] 赵剑[2] 赵卫东[3] 

机构地区：[1]同济大学附属同济医院骨科,上海市200065 [2]南通大学附属医院骨科,江苏省南通市226001 [3]南方医科大学生物力学实验室,广东省广州市510515

出　　处：《中国组织工程研究与临床康复》2009年第22期4245-4248,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景：自1968年Kimura首次描述了峡部裂的直接修复以来,直接修复峡部崩裂已成为青年患者合乎逻辑的术式,并发展了多种内固定形式以增加修复的成功率。目的：观察腰椎弓崩裂直接修复后采用改良Scott法固定的生物力学效应,并评价应用于青年患者的临床疗效。设计、时间及地点：分组设计,对比观察,于2003-10/2004-02在南方医科大学生物力学重点实验室完成。材料和对象：选用8具新鲜健康小牛L2～L6标本,由光明乳业南汇屠宰场提供;另选南通大学附属医院及同济大学附属同济医院骨科采用改良Scott法治疗的青年性腰椎弓崩裂患者12例,男8例,女4例;年龄16～31岁。方法：①生物力学实验：8具新鲜小牛标本,于L4椎弓峡部制作椎弓崩裂模型,在Spine2000测试仪上按正常组、椎弓崩裂组、改良Scott组、钩螺钉固定组和Buck螺钉组顺序分别测量腰椎不同运动状态下的稳定性。②临床试验：对12例单纯腰椎弓崩裂患者接受自体骨直接修复峡部裂后施行改良Scott法内固定,根据术后X射线结果评价修复效果,并根据MacNab’s标准进行临床评价。主要观察指标：根据术后X射线、CT结果评价修复效果（融合率）,并根据MacNab标准进行临床评价（包括疼痛、对工作的胜任能力）。结果：改良Scott法及另两种内固定方式均能显著增加固定强度,并有效恢复腰椎稳定性。12例患者随访时间6～19个月,平均13个月。术后未见椎弓根螺钉及钢丝松动、断裂,X射线峡部融合率为100%;患者下腰痛或放射痛等症状显著缓解,按MacNab’s标准,优8例,良3例,一般1例,优良率为92%。结论：改良Scott法是一种符合正常生理解剖的治疗青年性腰椎弓崩裂的方法,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,但需掌握适应证。BACKGROUND： Patients with lumbar spondylolysis and mild isthmic spondylolisthesis are mainly managed with direct repair of the defects additionally underwent a fusion procedure to obtain a high rate of bony healing since 1968. OBJECTIVE： To evaluate the biomechanical performance and clinical results of modified Scott wiring fixation after direct repair of lumbar spondylolytic defects in the pars interarticularis. DESIGN, TIME AND SE＇R＇ING： A randomized grouping design and observation study was performed at the Biomechanical Laboratory of Southern Medical University from October 2003 to February 2004. MATERIALS AND SUBJECTS： Eight fresh calf L2 L6 specimens were supplied by Bright Dairy Nanhui Slaughterhouse. Twelve young patients received treatment of modified Scott method at the Affiliated Tongji Hospital of Tongji University and Affiliated Hospital of Nantong University, including 8 males and 4 females, aged 16 31 years. METHODS： （1）Biomechanical study： The bilateral spondylolytic defects were created in the L4 vertebra in 8 calves. The stability of abdominal vertebra was measured on Spine2000 tester when spondylolytic spine fixed by modified Scott＇ s fixation, hook screw fixation and Buck＇s fixation sequentially and respectively. （2）Clinical study： 12 young male patients suffered from symptomatic lumbar spondylolysis were selected to be treated with modified Scott wiring fixation after direct repair of the defect. Conventional tomography scans were taken to assess the condition of the fixation and the healing of the bony defect; MacNab criteria including pain, work ability, were used to assess their prior to and postoperative status. MAIN OUTCOME MEASURES： The fusion rate was evaluated by postoperative X-ray film and CT, and the clinical evaluation was performed due to MacNab criteria including pain and work ability. RESULTS： Each fixation technique significantly increased stiffness and returned the intervertebral rotational stiffness to nearly intact levels. All patie

关 键 词：青年患者 椎弓崩裂 改良Scott法 内固定 生物力学 

分 类 号：R318.01[医药卫生—生物医学工程]