科学认识和规范应用腰椎经椎弓根动态固定技术  

Scientific understanding and standard application of lumbar transpedicular dynamic stabilization technique

作　　者：周强 Zhou Qiang(Department of Orthopaedics,the Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China)

机构地区：[1]重庆医科大学附属第三医院骨科,401120

出　　处：《中华骨科杂志》2021年第17期1175-1179,共5页Chinese Journal of Orthopaedics

摘　　要：腰椎经椎弓根动态固定技术是一类保留运动功能的脊柱后路固定技术,可弥补融合固定牺牲运动功能的缺陷,主要用于腰椎间盘突出症、退行性滑脱症、严重椎管狭窄症和轻中度退行性侧凸等腰椎退行性疾病。动态固定能卸载部分应力负荷,利于减缓固定节段的退变进程,无需植骨和等待融合,有利于促进术后快速康复、避免融合失败和减少内固定相关并发症。在临床应用中,正确选择手术适应证和严格把握禁忌证是取得良好疗效的前提。采用后正中切口Wiltse入路为宜,在上关节突与横突间沟槽底置钉,以便动态棒安放于关节突关节外侧,固定轴要尽可能接近腰椎运动轴,重视术后腰椎功能康复。腰椎经椎弓根动态固定是具有一定应用前景的新理念和新技术,因与坚强固定观念不同而在认识上存在分歧是难免的。推进其科学研究和临床规范是安全、正确应用这一技术并造福患者的前提。Lumbar transpedicular dynamic stabilization is a posterior spine fixation technique that preserves the lumbar function and remedies the loss of function by fixed fusion.It is mainly used in treating lumbar degenerative diseases,including lumbar disc herniation,degenerative spondylolisthesis,severe spinal stenosis and mild/moderate degenerative lumbar scoliosis and so on.Dynamic fixation can unload part of the stress,which could lead to slowing down the degeneration process of the fixed segments.Without bone grafting and waiting for fusion,it is conducive to have rapid postoperative recovery and to avoid fusion failure with reduced internal fixation-related complications.In clinical application,the correct indication selection and the strict contraindication exclusion are the precondition of good curative effects.The midline dorsal incision and Wiltse approach is advisable for the surgery.The pedicle screws were implanted at the bottom of the groove between the superior articular process and the transverse process.Thus,the dynamic rod could be placed on the lateral side of the facet joint,and should be as close as possible to the motion axis of the lumbar spine.More attention should be paid to postoperative functional rehabilitation of lumbar spine.The lumbar transpedicular dynamic stabilization is a promising new concept and technology.However,it is inevitable that there are differences in understanding this topic due to its difference from traditional strategies.Therefore,it is important to actively promote its scientific research and to correct standardized application in clinical practice.

关 键 词：椎管狭窄症 动态固定 经椎弓根 上关节突 关节突关节 手术适应证 横突间 固定节段 

分 类 号：R687.3[医药卫生—骨科学]