腰椎经椎弓根动态固定系统的研究进展  

Biomechanics and clinical effect of lumbar transpedicular dynamic fixation systems

作　　者：陈龙 简月奎[1] 赵伟峰[1] 周焯家[1] 李波[1] Chen Long;Jian Yuekui;Zhao Weifeng;Zhou Zhuojia;Li Bo(Department of Orthopaedics,Guizhou Provincial People's Hospital,Guiyang 550002,China)

机构地区：[1]贵州省人民医院骨科,贵阳550002

出　　处：《中华骨科杂志》2021年第17期1283-1290,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金(81960404)。

摘　　要：腰椎退行性疾病是骨科门诊最常见的疾病之一,其所致的慢性腰背痛严重影响患者的生活质量。椎间融合和刚性固定是目前手术治疗该疾病的主要手段。尽管椎间融合和刚性固定可获得较高的融合率,但是由于应力集中于邻近节段,所以可能会发生邻近节段退变,而邻近节段退变使得患者的满意率远低于影像学的融合率。动态固定是一种新的固定理念,可在控制脊柱节段异常运动的同时保留固定节段的部分活动,有利于减轻邻近节段退变和降低内固定物断裂的发生率。如今市场上出现了各种不同的腰椎经椎弓根动态固定系统,其设计理念大多源于20世纪80、90年代用于脊柱融合手术的椎弓根螺钉及杆,设计初衷是稳定异常节段并减轻退化椎间盘和小关节的压力,同时保持相应节段的正常运动。通过对常见后路腰椎经椎弓根动态固定系统的生物力学研究、临床疗效、存在的问题及优缺点进行综述,为临床医生治疗腰椎退行性疾病提供策略,同时为后路腰椎经椎弓根动态固定系统的设计改进提供新思路。Lumbar degenerative disease is one of the most common diseases in orthopaedic clinics,and the chronic low back pain caused by it seriously affects patients'living quality.Currently,intervertebral fusion and rigid fixation are the main surgical methods for lumbar degenerative disease.Although the intervertebral fusion and rigid fixation can achieve a higher fusion rate,due to the stress concentration of adjacent segments,the adjacent segment degeneration may occur and make the patient's satisfaction rate much lower than the imaging fusion rate.Dynamic fixation is a new fixing concept,which can control the abnormal motion of the spine segment while retaining part of the movement of the fixed segment.Moreover,dynamic fixation is also beneficial to reduce the degeneration of adjacent segments and the incidence of breakage of internal fixation.Nowadays,various lumbar transpedicular dynamic fixation systems have appeared on the market.Most of these transpedicular dynamic fixation systems are derived from the design of pedicle screws and rods used in spinal fusion surgery in the 1980 s and 1990 s.The original intention of their design is to stabilize the abnormal segments and reduce the pressure on degenerated intervertebral discs and facet joints,while maintaining the normal movement of relevant segments.By reviewing the biomechanical research,clinical efficacy,existing problems and advantages and disadvantages of common backward lumbar transpedicular dynamic fixation systems,this article intends to provide new ideas for the improvement of the backward lumbar transpedicular dynamic fixation system design,as well as offering surgical treatment strategies for clinicians.

关 键 词：邻近节段退变 经椎弓根 慢性腰背痛 椎间融合 临床医生 骨科门诊 固定节段 临床疗效 

分 类 号：R687.3[医药卫生—骨科学]