Bartochowski Łukasz, Jurasz Wojciech, Kruczyński Jacek
Department of General Orthopaedics, Orthopaedic Oncology and Traumatology, University of Medical Sciences, Poznań, Poland.
Wiktor Dega Hospital in Poznań, 28 czerwca 1956r. Street Number 135/147, 61-493, Poznań, Poland.
Eur J Orthop Surg Traumatol. 2017 Oct;27(7):1011-1017. doi: 10.1007/s00590-017-1974-0. Epub 2017 May 11.
Both spondylolysis and spondylolisthesis come in second place in the causes of pain among athletes. Treatment options include both conservative management and different operative methods. Athletes and adolescents are groups where the priority is to protect tissues from perioperative damage.
We present our modification of the Buck's, direct pars repair method, which we believe offers maximum protection of tissues. We used the modified surgical method in young, competitive athletes, in whom non-surgical treatment was not effective.
Eight pars defects in five patients were treated using suggested method. All of them were young males (aged between 13 and 18 years), who practice soccer professionally. We use modified method of direct repair pars through the cannulated screw fixation, first proposed by Buck. Preoperative preparation consists of proper analysis of computer tomography images in multiplanar reconstruction mode: measuring screw length, measurement of inclination angle of the optimal screw trajectory in the frontal and sagittal plane. During the operation, the wire proper direction is performed by usage of the predetermined angles. Starting point for guide wire was also changed to the lower end of the facet. The fusion takes place with a screw of 3 mm diameter. After the operation patient need to use thoracolumbar spinal orthosis as a primary immobilization for 6 weeks and appropriate rehabilitation for another 6 weeks. We used these methods in eight pars fixations.
All of the patients were painless in first week after surgery. All of them underwent total rehabilitation programme and returned to sport.
Direct pars repair using Buck's method with proposed modification, including adequate radiographic preparation, the use of a thin cannulated screw and changing the point of screw entry, allows precise and safe screw placement, regardless of the size of the bone at the defect site.
椎弓峡部裂和椎体滑脱在运动员疼痛原因中均位列第二。治疗选择包括保守治疗和不同的手术方法。运动员和青少年群体的首要任务是保护组织免受围手术期损伤。
我们展示了对巴克直接峡部修复方法的改良，我们认为该方法能最大程度地保护组织。我们在非手术治疗无效的年轻竞技运动员中使用了改良后的手术方法。
使用建议的方法治疗了5例患者的8处峡部缺损。他们均为年轻男性（年龄在13至18岁之间），从事职业足球运动。我们采用经空心螺钉固定直接修复峡部的改良方法，该方法最初由巴克提出。术前准备包括以多平面重建模式对计算机断层扫描图像进行适当分析：测量螺钉长度，测量额面和矢状面最佳螺钉轨迹的倾斜角度。手术过程中，通过使用预定角度来确定钢丝的正确方向。导丝的起始点也改为小关节的下端。使用直径3毫米的螺钉进行融合。术后患者需使用胸腰椎脊柱矫形器作为主要固定方式6周，并进行另外6周的适当康复治疗。我们在8例峡部固定中使用了这些方法。
所有患者术后第一周均无疼痛。他们均接受了全面的康复计划并重返运动。
采用改良后的巴克方法进行直接峡部修复，包括充分的影像学准备、使用细空心螺钉以及改变螺钉置入点，无论缺损部位骨骼大小如何，均可实现精确且安全的螺钉置入。
