从临床积累中不断探索腰椎经椎弓根动态固定的应用范围及其价值  

Exploring the application indications and value of lumbar transpedicular dynamic stabilization based on its clinical practice

作　　者：郑燕平[1] 刘新宇[1] Zheng Yanping;Liu Xinyu(Department of Spine Surgery,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院脊柱外科,济南250012

出　　处：《中华骨科杂志》2021年第17期1171-1174,共4页Chinese Journal of Orthopaedics

摘　　要：腰椎后路融合术是被脊柱外科医生广泛认可并成为共识的治疗腰椎退行性疾病的有效方法之一。然而固定融合会带来一系列的问题,尤其是邻近节段退变,已成为腰椎固定融合术后再手术的主要原因之一。在此情况下,动态固定治疗腰椎疾患逐渐受到脊柱外科医生的关注。腰椎经椎弓根动态固定系统作为刚性融合的替代逐渐应用于临床,因其能够在维持手术节段稳定性的同时保留一定椎间活动度的特点而成为目前应用最广泛的非融合术式之一。但一项新术式的出现必然会与传统观念相碰撞,国内外学者从生物力学、临床疗效及预后等多个方面对腰椎动态固定技术进行了探索和评价。本期文章探究了腰椎经椎弓根动态固定在腰椎常见的退行性疾病中的应用及相关并发症,综合来看该技术临床疗效得到了多项研究的证实,可作为刚性融合术式的一种替代来辅助治疗神经减压后的节段不稳。但目前仍存在许多不足,需要针对适应证、禁忌证、优缺点及相关风险开展多中心对照试验,同时对固定装置进行革新和研发,设计出符合国人解剖学特点的动态固定系统,使该项技术充分发挥其应有的作用。Posterior lumbar fusion is one of the effective methods for the treatment of lumbar degenerative diseases,which have been recognized by the majority of spine surgeons.However,it is found that lumbar fusion brings some problems with application,research and understanding move on.Adjacent segments degeneration(ASD)is one of the main reasons for reoperation after lumbar fixation and fusion.Therefore,dynamic stabilization system used in lumbar diseases has become a research hotspot in spinal surgery.Regarded as an alternative instead of rigid fusion,lumbar transpedicular dynamic stabilization system is gradually applied in clinical practice.It has become one of the most widely used non-fusion methods due to its advantages on maintaining the stability of surgical segments and on retaining intervertebral mobility.However,an emergence of new technique often meets conflicts from traditional concepts.Scholars have explored and evaluated the lumbar dynamic fixation technology in the aspects of biomechanics,clinical efficacy and prognosis.Some studies have explored the application and its related complications of lumbar transpedicular dynamic stabilization in common lumbar degenerative diseases.Comprehensively,the clinical effects of this technology have been confirmed by many studies.It can be used as an alternative instead of rigid fusion in the treatment of unstable segments after nerve decompression.There are still some limitations of this technique.It is necessary to conduct more multi-center randomized controlled trials according to the indications,contraindications,advantages,disadvantages and related risks.Further studies could improve the device in line with the anatomical characteristics of Chinese people and serve patients better.

关 键 词：解剖学特点 经椎弓根 动态固定 神经减压 新术式 腰椎疾患 临床疗效 禁忌证 

分 类 号：R687.3[医药卫生—骨科学]