下颈椎后路椎弓根螺钉置钉方法的研究进展  

Advance in screws fixation in posterior route pedicle on lower cervical spine

作　　者：邹云龙[1] 刘宇龙[1] 张瀚雷 胡海峰[1] 肖博晗[1] 王永琨[1] 刘景臣[1] 朱庆三[1] 李野[1] 

机构地区：[1]吉林大学中日联谊医院骨科,长春130033

出　　处：《中华骨科杂志》2017年第10期629-635,共7页Chinese Journal of Orthopaedics

摘　　要：椎弓根螺钉技术最早应用于胸腰椎，近年来学者们对颈椎椎弓根解剖特点的不断探索，为颈椎植入椎弓根螺钉带来了技术上的突破。此外，颈椎后路椎弓根螺钉固定技术安全且可靠，工具简单且适应证广泛，利用椎弓根螺钉在术中有较好的提拉、复位、矫形作用这一优势，可广泛应用于创伤导致的颈椎骨折、颈椎不稳、退变、炎症、良恶性肿物以及畸形等众多颈部疾病。由于上颈椎（C1、C2）和下颈椎（C3-7）在解剖形态上存在巨大差异，所以C1和C2有各自独立的置钉方法，C3-7因结构相近，置钉方法在原则上应是自成一套体系，有着众多共同点。目前，依据操作手段不同，置钉方式总体上分为两类：导航下置钉和徒手置钉。导航模拟置钉不依靠经验，简单、直视、可靠，但是步骤繁多、设备昂贵，且有导航漂移的风险，因此徒手置钉方法的研究显得尤为重要和必要。本综述分别从下颈椎椎弓根及其相邻结构的解剖特点及椎弓根结构的测量等角度对当前的下颈椎椎弓根螺钉的徒手置钉技术以及椎弓根螺钉的生物力学研究进行分析、概括，并总结、对比了当下具有代表性的徒手置钉技术的优点及不足。With the continuously exploration, in recent years, further understanding of anatomical characteristics of the cervical pedicle brings great breakthrough in cervical pedicle screw implantation. In addition, pedicle screw implantation in cervi- cal spine is considered as a technique with high safety and reliability, which can be widely used in cervical trauma fracture, cervi- cal instability, degenerative, inflammatory, benign or malignant tumor, deformity and other neck diseases. Because of the tremen- dous differences between upper cervical spine （C,, C2） and lower cervical spine （C3 7） in anatomical morphology, cervical pedicle screw implantation in C~ and C2 differs from in lower cervical spine. Due to the similar structure of C3-7, pedicle screw implantation methods are based on the same principle and sharing a few points in common. The pedicle screw technique can be classified in two groups according to the practice methods： navigation technology and manual placement of cervical pedicle screw. Navigation nailing is considered as reliable, easy handing, and with clear operative vision, however, with disadvantages as complex proce- dures, highly cost operation equipment, and risk in navigation draft. Therefore, manual placement of pedicle screw is more reason- able and practical comparing with the former. In this study, it analyzed anatomical characteristics of lower cervical pediele and the measurement of pedicle structure, discussed technique of manual placement of pedicle screw in lower cervical spine and biome- ehanieal study of pedicle screw, and summed up the comparison of the advantages and disadvantages of current representative manual placement technology.

关 键 词：后路椎弓根螺钉 置钉方法 下颈椎 颈椎椎弓根螺钉 椎弓根螺钉技术 椎弓根螺钉固定 解剖特点 技术安全 

分 类 号：R687.3[医药卫生—骨科学]