腰椎棘突间撑开器的特点及临床适用性  

Characteristics and clinical applicability of lumbar interspinous spacer

作　　者：王宝东 芦俊峰 曹杨[1] Wang Bao-dong;Lu Jun-feng;Cao Yang(First Affiliated Hospital of Harbin Medical University,Harbin 150001,Heilongjiang Province,China)

机构地区：[1]哈尔滨医科大学附属第一医院,黑龙江省哈尔滨市150001

出　　处：《中国组织工程研究》2018年第31期5041-5047,共7页Chinese Journal of Tissue Engineering Research

基　　金：哈尔滨市科学技术局(2013AA3BS016)~~

摘　　要：背景:腰椎退行性疾病是骨科常见疾病之一,治疗方法有保守治疗、椎体间融合术、椎体间非融合术,其经典手术治疗方法是后路腰椎体间融合术。非融合技术临床应用日益广泛,棘突间撑开器是其中一个重要代表,与传统融合技术相比具有独特的生物力学优势和较理想的临床疗效,但潜在的问题与不足随着应用的增多也逐渐显现。目的:对腰椎棘突间撑开器的生物力学特点及弊端,临床适用性的价值与争议,以及临床适用性受限原因和生物力学方面的改进理念进行综述,为广大临床医生及进一步的研究提供参考。方法:第一作者以"腰椎,棘突间撑开器,棘突间撑开装置,生物力学,临床治疗效果,成本效益,腰椎棘突间撑开器并发症,棘突间撑开器适应证和禁忌证,棘突形态,新型棘突间撑开器"为关键词在中国知网、万方数据库进行检索,在Pub Med数据库、Springer Link数据库以"Lumbar spine,interspinous spacer,interspinousdevices,biomechanics,clinicaltherapeuticeffect,cost-effectiveness,complicationsof interspinous spacer,indication and contraindication of interspinous spacer,spinous process morphology,new interspinous spacer"进行检索。采纳2003至2018年的相关研究,排除重复研究。通过阅读摘要初步筛选,共选取42篇文献进行综述,其中中文文献4篇,英文文献38篇。结果与结论:(1)腰椎棘突间撑开器具有独特生物力学特点,与此同时,棘突间撑开器自身结构设计上也存在一些弊端;(2)各种腰椎棘突间撑开装置在短、中期随访中均具有良好的临床疗效,但仍存在复发率及二次翻修手术率高、临床疗效不确切、成本效益低、并发症频出等问题;(3)手术适应证和禁忌证掌握不准确,术中操作不规范,棘突解剖形态存在特异性是临床适用性受限的主要原因;(4)一些新型棘突间撑开器的研发为棘突间撑开器生物力学研究提供了改进理念与方向。BACKGROUND:Lumbar degenerative disease is a common disease in orthopedics.The treatment methods include conservative treatment,interbody fusion and interbody non-fusion,and the classical surgical treatment is posterior lumbar interbody fusion.Non-fusion technology has become more and more widely used,especially the interspinous spacer.Compared with the traditional fusion technology,it has unique biomechanical advantages and ideal clinical efficacy,but the potential problems and deficiencies are gradually emerging.OBJECTIVE:To review the biomechanical characteristics and disadvantages of interspinous spacer,the value and controversy of clinical applicability,the reasons for the limitation of clinical applicability and the improvement in biomechanics,so as to provide a reference for clinical practice.METHODS:The first author retrieved CNKI,WanFang,PubMed and SpringerLink databases with the keywords of“lumbar spine,interspinous spacer,interspinous devices,biomechanics,clinical therapeutic effect,cost-effectiveness,complications of interspinous spacer,indication and contraindication of interspinous spacer,spinous process morphology,new interspinous spacer”in English and Chinese,respectively.Relevant studies published between 2003 and 2018 were included and the repeated studies were excluded.Finally,42 studies were enrolled,with 38 English studies and 4 Chinese studies through reading abstracts.RESULTS AND CONCLUSION:(1)The interspinous spacer holds special biomechanical characteristics and certain shortcomings in structure.(2)All kinds of interspinous spacers obtain good clinical effects in short-and medium-time follow-up.However,there are some disadvantages,such as high rate of recurrence and reversion,inaccurate clinical efficacy,low cost-effectiveness,and frequent complications.(3)The inaccurate surgical indications and contraindications,unstandardized operation and the specificity in the anatomic morphology of spinous process are the main reasons for the limitation of clinical applicability.(4)The research an

关 键 词：腰椎 棘突间撑开器 生物力学 临床治疗效果 成本效益 并发症 适应证和禁忌证 棘突形态 改进理念 腰椎 生物力学 内固定器 组织工程 

分 类 号：R318[医药卫生—生物医学工程]