• 第四軍醫(yī)大學(xué)唐都醫(yī)院骨科（西安，710038）;

目的回顧和總結(jié)直接修復(fù)法治療青少年腰椎椎弓崩裂的手術(shù)方式及臨床療效。 方法查閱國內(nèi)外關(guān)于直接修復(fù)法治療青少年腰椎椎弓崩裂手術(shù)方式及臨床療效的相關(guān)文獻(xiàn)，進(jìn)行綜述分析。 結(jié)果直接修復(fù)法治療腰椎椎弓崩裂僅在傷椎上進(jìn)行簡單且符合正常生理解剖的復(fù)位固定，維持其原有的解剖結(jié)構(gòu)。按照文獻(xiàn)報(bào)道的直接修復(fù)內(nèi)固定方法（單一拉力螺釘固定、帶鉤螺釘固定、鋼絲環(huán)扎內(nèi)固定、椎弓根螺釘鋼絲固定、椎弓根釘棒系統(tǒng)固定、椎弓根釘鉤系統(tǒng)固定），青少年椎弓崩裂患者均取得了較好療效。手術(shù)適應(yīng)證的嚴(yán)格控制、內(nèi)固定的正確選擇是直接修復(fù)法獲得良好療效的保證。在各種方法中，椎弓根釘鉤系統(tǒng)固定是一種已被廣泛認(rèn)同的內(nèi)固定方式。 結(jié)論椎弓根釘鉤系統(tǒng)直接修復(fù)治療青少年腰椎椎弓崩裂簡便易行，療效確實(shí)，且隨著該技術(shù)的完善及微創(chuàng)技術(shù)的發(fā)展，其應(yīng)用可能會(huì)更加廣泛。

引用本文： 劉海潮,錢濟(jì)先. 直接修復(fù)法治療青少年腰椎椎弓崩裂的臨床研究進(jìn)展. 中國修復(fù)重建外科雜志, 2013, 27(1): 106-109. doi: 復(fù)制

1. Kim HJ, Green DW. Spondylolysis in the adolescent athlete. Curr Opin Pediatr, 2011, 23(1): 68-72.
2. Gurd DP. Back pain in the young athlete. Sports Med Arthrosc, 2011, 19(1): 7-16.
3. Schlenzka D, Remes V, Helenius I, et al. Direct repair for treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in young patients: no benefit in comparison to segmental fusion after a mean follow-up of 14.8 years. Eur Spine J, 2006, 15(10): 1437-1447.
4. Wilms GE, Willems E, Demaerel P, et al. CT volumetry of lumbar vertebral bodies in patients with hypoplasia L5 and bilateral spondylolysis and in normal controls. Neuroradiology, 2012, 54(8): 839-843.
5. Sairyo K, Sakai T, Mase Y, et al. Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study. Arch Orthop Trauma Surg, 2011, 131(11): 1485-1489.
6. Zukotynski K, Curtis C, Grant FD, et al. The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain. J Orthop Surg Res, 2010, 5: 13.
7. Kimura M. My method of filing the lesion with spongy bone in spondylolysis and spondylolistesis . Seikei Geka, 1968, 19(4): 285-296.
8. Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg (Br), 1970, 52(3): 432-437.
9. Brennan RP, Smucker PY, Horn EM, et al. Minimally invasive image-guided direct repair of bilateral L-5 pars interarticularis defects. Neurosurg Focus, 2008, 25(2): E13.
10. Rajasekaran S, Subbiah M, Shetty AP, et al. Direct repair of lumbar spondylolysis by Buck’s technique. Indian J Orthop, 2011, 45(2): 136-140.
11. Morscher E, Gerber B, Fasel J, et al. Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg, 1984, 103(3): 175-178.
12. Ivanic GM, Pink TP, Achatz W, et al. Direct stabilization of lumbar spondylolysis with a hook screw: mean 11-year follow-up period for 113 patients. Spine (Phila Pa 1976), 2003, 28(3): 255-259.
13. Nicol RO, Scott JH. Lytic spondylolysis. Repair by wiring. Spine (Phila Pa 1976), 1986, 11(10): 1027-1030.
14. Nozawa S, Shimizu K, Miyamoto K, et al. Repair of pars interarticularis defect by segmental wire fixation in young athletes with spondylolysis. Am J Sports Med, 2003, 31(3): 359-364.
15. Askar Z, Wardlaw D, Koti M, et al. Scott wiring for direct repair of lumbar spondylolysis. Spine (Phila Pa 1976), 2003, 28(4): 354-357.
16. Bozarth GR, Fogel GR, Toohey JS, et al. Repair of pars interarticularis defect with a modified cable-screw construct. J Surg Orthop Adv, 2007, 16(2): 79-83.
17. Songer MN, Rovin R. Repair of the pars interarticularis defect with a cable-screw construct. A preliminary report. Spine (Phila Pa 1976), 1998, 23(2): 263-269.
18. Giudici F, Minoia L, Archetti M, et al. Long-term results of the direct repair of spondylolisthesis. Eur Spine J, 2011, 20 Suppl 1: S115-120.
19. Gillet P, Petit M. Direct repair of spondylolysis without spondylolisthesis, using a rod-screw construct and bone grafting of the pars defect. Spine (Phila Pa 1976), 1999, 24(12): 1252-1256.
20. Altaf F, Osei NA, Garrido E, et al. Repair of spondylolysis using compression with a modular link and screws. J Bone Joint Surg (Br), 2011, 93(1): 73-77.
21. Tokuhashi Y, Matsuzaki H. Repair of defects in spondylolysis by segmental pedicular screw hook fixation. A preliminary report. Spine (Phila Pa 1976), 1996, 21(17): 2041-2045.
22. Noggle JC, Sciubba DM, Samdani AF, et al. Minimally invasive direct repair of lumbar spondylolysis with a pedicle screw and hook construct. Neurosurg Focus, 2008, 25(2): E15.
23. Debusscher F, Troussel S. Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and Ct-assessed study. Eur Spine J, 2007, 16(10): 1650-1658.
24. Patel RD, Rosas HG, Steinmetz MP, et al. Repair of pars interarticularis defect utilizing a pedicle and laminar screw construct: a new technique based on anatomical and biomechanical analysis. J Neurosurg Spine, 2012, 17(1): 61-68.
25. Sairyo K, Sakai T, Yasui N, et al. Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system. J Neurosurg Spine, 2009, 10(5): 492-495.
  1. 1. Kim HJ, Green DW. Spondylolysis in the adolescent athlete. Curr Opin Pediatr, 2011, 23(1): 68-72.
  2. 2. Gurd DP. Back pain in the young athlete. Sports Med Arthrosc, 2011, 19(1): 7-16.
  3. 3. Schlenzka D, Remes V, Helenius I, et al. Direct repair for treatment of symptomatic spondylolysis and low-grade isthmic spondylolisthesis in young patients: no benefit in comparison to segmental fusion after a mean follow-up of 14.8 years. Eur Spine J, 2006, 15(10): 1437-1447.
  4. 4. Wilms GE, Willems E, Demaerel P, et al. CT volumetry of lumbar vertebral bodies in patients with hypoplasia L5 and bilateral spondylolysis and in normal controls. Neuroradiology, 2012, 54(8): 839-843.
  5. 5. Sairyo K, Sakai T, Mase Y, et al. Painful lumbar spondylolysis among pediatric sports players: a pilot MRI study. Arch Orthop Trauma Surg, 2011, 131(11): 1485-1489.
  6. 6. Zukotynski K, Curtis C, Grant FD, et al. The value of SPECT in the detection of stress injury to the pars interarticularis in patients with low back pain. J Orthop Surg Res, 2010, 5: 13.
  7. 7. Kimura M. My method of filing the lesion with spongy bone in spondylolysis and spondylolistesis . Seikei Geka, 1968, 19(4): 285-296.
  8. 8. Buck JE. Direct repair of the defect in spondylolisthesis. Preliminary report. J Bone Joint Surg (Br), 1970, 52(3): 432-437.
  9. 9. Brennan RP, Smucker PY, Horn EM, et al. Minimally invasive image-guided direct repair of bilateral L-5 pars interarticularis defects. Neurosurg Focus, 2008, 25(2): E13.
  10. 10. Rajasekaran S, Subbiah M, Shetty AP, et al. Direct repair of lumbar spondylolysis by Buck’s technique. Indian J Orthop, 2011, 45(2): 136-140.
  11. 11. Morscher E, Gerber B, Fasel J, et al. Surgical treatment of spondylolisthesis by bone grafting and direct stabilization of spondylolysis by means of a hook screw. Arch Orthop Trauma Surg, 1984, 103(3): 175-178.
  12. 12. Ivanic GM, Pink TP, Achatz W, et al. Direct stabilization of lumbar spondylolysis with a hook screw: mean 11-year follow-up period for 113 patients. Spine (Phila Pa 1976), 2003, 28(3): 255-259.
  13. 13. Nicol RO, Scott JH. Lytic spondylolysis. Repair by wiring. Spine (Phila Pa 1976), 1986, 11(10): 1027-1030.
  14. 14. Nozawa S, Shimizu K, Miyamoto K, et al. Repair of pars interarticularis defect by segmental wire fixation in young athletes with spondylolysis. Am J Sports Med, 2003, 31(3): 359-364.
  15. 15. Askar Z, Wardlaw D, Koti M, et al. Scott wiring for direct repair of lumbar spondylolysis. Spine (Phila Pa 1976), 2003, 28(4): 354-357.
  16. 16. Bozarth GR, Fogel GR, Toohey JS, et al. Repair of pars interarticularis defect with a modified cable-screw construct. J Surg Orthop Adv, 2007, 16(2): 79-83.
  17. 17. Songer MN, Rovin R. Repair of the pars interarticularis defect with a cable-screw construct. A preliminary report. Spine (Phila Pa 1976), 1998, 23(2): 263-269.
  18. 18. Giudici F, Minoia L, Archetti M, et al. Long-term results of the direct repair of spondylolisthesis. Eur Spine J, 2011, 20 Suppl 1: S115-120.
  19. 19. Gillet P, Petit M. Direct repair of spondylolysis without spondylolisthesis, using a rod-screw construct and bone grafting of the pars defect. Spine (Phila Pa 1976), 1999, 24(12): 1252-1256.
  20. 20. Altaf F, Osei NA, Garrido E, et al. Repair of spondylolysis using compression with a modular link and screws. J Bone Joint Surg (Br), 2011, 93(1): 73-77.
  21. 21. Tokuhashi Y, Matsuzaki H. Repair of defects in spondylolysis by segmental pedicular screw hook fixation. A preliminary report. Spine (Phila Pa 1976), 1996, 21(17): 2041-2045.
  22. 22. Noggle JC, Sciubba DM, Samdani AF, et al. Minimally invasive direct repair of lumbar spondylolysis with a pedicle screw and hook construct. Neurosurg Focus, 2008, 25(2): E15.
  23. 23. Debusscher F, Troussel S. Direct repair of defects in lumbar spondylolysis with a new pedicle screw hook fixation: clinical, functional and Ct-assessed study. Eur Spine J, 2007, 16(10): 1650-1658.
  24. 24. Patel RD, Rosas HG, Steinmetz MP, et al. Repair of pars interarticularis defect utilizing a pedicle and laminar screw construct: a new technique based on anatomical and biomechanical analysis. J Neurosurg Spine, 2012, 17(1): 61-68.
  25. 25. Sairyo K, Sakai T, Yasui N, et al. Minimally invasive technique for direct repair of pars interarticularis defects in adults using a percutaneous pedicle screw and hook-rod system. J Neurosurg Spine, 2009, 10(5): 492-495.