von Strempel Archibald
Orthopädische Abteilung, Landeskrankenhaus Feldkirch, Feldkirch, Österreich.
Oper Orthop Traumatol. 2010 Nov;22(5-6):561-72. doi: 10.1007/s00064-010-9016-7.
Stabilization of unstable motion segments with a stable but non-rigid implant system without an additional spondylodesis.
Neurogenic claudication with instability; discogenic pain; in combination with a fusion (hybrid technique); elongation of a preexisting fusion; second recurrence of a herniated disk.
Increased instability; correction and reduction; instrumentation of more than three levels.
Muscle-sparing approach to the posterior lumbar spine under anteroposterior and lateral image control. Use of special instruments with a slotted sleeve connected to the screw head for rod implantation. Alternatively: conventional midline approach with detachment of muscles from the posterior spine.
Mobilization on the day after surgery. Limited physical activities and no work load for 6 weeks.
In 139 patients (77 females, 62 males, average age 55 years) with a follow-up of 2 years, Oswestry score improved from 49.0% preoperatively to 22.5% and VAS (visual analog scale) from 7.3 preoperatively to 2.5 after 2 years. No change of the lordosis. Eleven revisions (7.9%). Two broken screws (0.3%) and 17 screws (2.5%) with a radiolucent halo.
使用稳定但非刚性的植入系统稳定不稳定的运动节段，无需额外的脊柱融合术。
伴有不稳定的神经源性间歇性跛行；椎间盘源性疼痛；与融合术联合使用（混合技术）；已有融合术的延长；椎间盘突出症的二次复发。
不稳定增加；矫正和复位；超过三个节段的内固定。
在前后位和侧位影像控制下采用保留肌肉的后路腰椎入路。使用特殊器械，其带槽套筒连接到螺钉头部用于植入棒。或者：采用传统的中线入路，从后脊柱分离肌肉。
术后第一天即可活动。6周内限制体力活动且不承担工作负荷。
139例患者（77例女性，62例男性，平均年龄55岁），随访2年，Oswestry评分从术前的49.0%改善至22.5%，视觉模拟量表（VAS）评分从术前的7.3降至术后2年的2.5。脊柱前凸无变化。11例翻修（7.9%）。2枚螺钉断裂（0.3%），17枚螺钉出现透亮晕（2.5%）。
