Kornblatt M D, Casey M P, Jacobs R R
Clin Orthop Relat Res. 1986 Feb(203):141-50.
While the posterolateral technique is the accepted fusion method for chronic mechanical back pain, the results are variable and the indications are narrow. In an attempt to resolve this problem the role of internal fixation has been explored. Relative stiffness and strength under flexion loading of four lumbosacral fixation systems--(1) translaminar facet joint screws, (2) Luque rectangular box, (3) Luque fixation to the pelvis via the Galveston technique, and (4) two-part pelvic spinal rod system--were evaluated and compared to the normal spine with and without posterior ligaments. The stiffness of the normal intact spine was found to be nonlinear: the bending moment is a function of the square of the flexion rotation. Internal fixation resulted in a twofold increase in stiffness. Facet screws were 20% stiffer and the pelvic-spinal system 2.3 times stiffer (p = 0.001) than the Luque systems but all had similar strength. A retrospective study of 135 consecutive posterolateral lumbosacral spine fusions was conducted to determine what factors improved the fusion rate, clinical results, and time to fusion. Diagnosis and previous surgical treatment, discectomy or fusion, were of no significance. The radiographic and clinical results were highly correlated (p = 0.0001). Electrical stimulation failed to improve the results. Internal fixation with facet joint screws or rods to the pelvis was found to statistically decrease the pseudarthrosis rate and reduce the time required for spine fusion (p = 0.02). The surgical technique consists of translaminar facet screws and segmental fixation to the pelvis using a new implant system.
虽然后外侧技术是治疗慢性机械性背痛公认的融合方法，但结果不一且适应证较窄。为解决这一问题，人们探索了内固定的作用。对四种腰骶部固定系统在屈曲负荷下的相对刚度和强度进行了评估并与有无后韧带的正常脊柱作比较，这四种系统分别是：（1）经椎板小关节螺钉；（2）鲁克矩形棒；（3）经加尔维斯顿技术将鲁克棒固定于骨盆；（4）双节段骨盆脊柱棒系统。发现正常完整脊柱的刚度呈非线性：弯矩是屈曲旋转角度平方的函数。内固定使刚度增加了两倍。小关节螺钉的刚度比鲁克系统高20%，骨盆-脊柱系统的刚度是鲁克系统的2.3倍（p = 0.001），但所有系统的强度相似。对135例连续的腰骶部后外侧脊柱融合术进行了回顾性研究，以确定哪些因素可提高融合率、临床效果和融合时间。诊断及既往手术治疗（椎间盘切除术或融合术）并无显著意义。影像学和临床结果高度相关（p = 0.0001）。电刺激未能改善结果。发现使用小关节螺钉或骨盆棒进行内固定在统计学上可降低假关节形成率并减少脊柱融合所需时间（p = 0.02）。手术技术包括经椎板小关节螺钉以及使用一种新的植入系统对骨盆进行节段性固定。
