Kakiuchi M
Osaka Police Hospital, Kitayama-cho, Tennoji-ku, Japan.
J Bone Joint Surg Am. 1997 Jun;79(6):818-25. doi: 10.2106/00004623-199706000-00003.
Direct repair of a defect in the pars interarticularis was performed with use of bone-grafting and internal fixation with a pedicle screw, rod, and laminar hook in order to achieve a higher prevalence of osseous union than that achieved with commonly used procedures. The configuration of the head of the screw, which is designed to allow it to connect with the rod at the necessary angle, simplified the placement of the rod. The procedure was performed in sixteen patients who had a bilateral defect of the pars interarticularis with or without grade-I or II spondylolisthesis, had had failure of non-operative treatment, and had had temporary relief of pain after the area of the defect in the pars interarticularis had been infiltrated with lidocaine. Concomitant degeneration of a disc was not a criterion for exclusion. The patients were followed for an average of twenty-five months (range, twenty-four to twenty-eight months). The average age at the time of the operation was thirty-two years (range, twelve to sixty years). Six patients had findings of nerve-root compression on myelography with computerized tomographic scanning, and the bone spurs overlying the affected nerve root around the defect in the pars interarticularis were removed with an ultrasonic osteotome through a small window. The implant was removed about one year after the operation. Oblique radiographs showed osseous union in the previous defect bilaterally in all sixteen patients. Thirteen patients were free of symptoms, and three had major improvement with occasional low-back pain. None had a complication, such as infection, breakage of the implant, or irritation of a nerve root. The method used for direct repair of the defect of the pars interarticularis in these patients proved to be simple and effective. Relief of symptoms appeared to depend on decompression of the affected nerve root, if one was involved, and on preoperative prediction of the locus of the symptoms by infiltration of the pars interarticularis with lidocaine.
采用植骨术及椎弓根螺钉、棒和椎板钩内固定术对关节突间部缺损进行直接修复，以期获得比常用手术更高的骨愈合率。螺钉头部的设计允许其以所需角度与棒连接，简化了棒的放置。该手术应用于16例患者，这些患者存在双侧关节突间部缺损，伴或不伴Ⅰ级或Ⅱ级椎体滑脱，非手术治疗失败，且在关节突间部缺损区域注射利多卡因后疼痛暂时缓解。椎间盘的同时退变并非排除标准。对患者平均随访25个月（范围24至28个月）。手术时的平均年龄为32岁（范围12至60岁）。6例患者在计算机断层扫描脊髓造影检查时有神经根受压表现，通过小窗口用超声骨刀切除关节突间部缺损周围压迫受累神经根的骨赘。术后约1年取出植入物。斜位X线片显示，所有16例患者双侧先前缺损处均有骨愈合。13例患者无症状，3例有明显改善，偶尔有下腰痛。无一例发生感染、植入物断裂或神经根刺激等并发症。事实证明，用于这些患者关节突间部缺损直接修复的方法简单有效。症状缓解似乎取决于受累神经根（若存在）的减压，以及术前通过在关节突间部注射利多卡因对症状部位的预测。
