后路枢椎峡部螺钉固定技术的研究进展  

Advancements in the posterial fixation with axial isthmus screws

作　　者：卢敏明 唐一钒 陈雄生 Lu Minming;Tang Yifan;Chen Xiongsheng(Department of Spine Surgery,Shanghai Changzheng Hospital,Naval Military Medical University,Shanghai 200003,China)

机构地区：[1]海军军医大学第二附属医院(上海长征医院)脊柱外科,上海200003

出　　处：《中华骨科杂志》2022年第23期1588-1594,共7页Chinese Journal of Orthopaedics

摘　　要：枢椎椎弓根螺钉固定技术作为经典的后路固定技术,因能够贯穿椎体达到三柱固定而具有优良的生物力学性能,是后路枢椎螺钉固定技术的首选和金标准,在颈椎外科得到广泛应用。但是随着临床研究的不断深入,部分学者报告枢椎椎弓根螺钉在椎弓根发育不全、椎动脉高跨及难复性寰枢椎脱位等患者中的应用受限,同时存在置钉时为暴露骨性标志而对肌肉剥离范围较大的缺陷。枢椎峡部螺钉固定技术作为枢椎椎弓根螺钉技术的一种补充,近年来逐渐得到学者们的关注,开始应用于各种类型颈椎疾病的外科治疗。枢椎峡部螺钉固定技术进钉点相对于椎弓根螺钉更靠近脊柱中线和下方关节突关节,可避免术中广泛的肌肉剥离,使椎旁肌得到保护,从而让手术创伤更小,进一步降低了手术的侵袭性。由于进钉点的改变,相较于寰椎侧块或椎弓根螺钉联合枢椎椎弓根螺钉的置钉方式,寰椎侧块或椎弓根螺钉联合枢椎峡部螺钉的置钉方式可使寰枢椎螺钉的钉头前后及垂直距离增加,为寰枢椎脱位患者的复位提供了更加宽阔的手术操作空间。由于枢椎属于上颈椎与下颈椎之间的过渡性椎体,其解剖结构复杂且变异多见,导致很多学者对枢椎峡部螺钉这种新技术的认识有限;而且置钉方案及手术细节无统一规范,大多依据临床医生的个人经验;该部位置钉技术的生物力学性能、手术并发症及远期疗效等还缺少研究数据,导致其在临床应用及推广方面受到限制。根据现有的文献报道,评估枢椎峡部螺钉的优势和缺陷,对枢椎峡部螺钉固定技术的解剖学、生物力学、临床应用及手术并发症等方面进行归纳、概括和分析,以期对枢椎峡部置钉的安全性及可行性提供参考依据。Axial pedicle screw fixation technique,as a classic posterior fixation technique,is the first choice and gold standard of posterior axial screw fixation.Since it can pass through the whole vertebrae and play the role of three-column fixation,it has excellent biomechanical properties and is widely used in cervical spine surgery.However,with the deepening of clinical research,some scholars found that the application of axial pedicle screws was limited in patients with pedicle hypoplasia,high-riding vertebral artery and irreducible atlantoaxial dislocation.At the same time,in order to expose bone markers during screw placement,the muscle dissection of pedicle screws is wider compared with that of isthmus screws.Isthmus screw fixation,as a complementary technique for pedicle screw technique,has gradually attracted the attention of scholars in recent years and has been applied in the surgical treatment of various types of cervical spine diseases.The entry point of axial isthmus screw is closer to the midline of the spine and the inferior facet joint than pedicle screw,to avoid extensive muscle dissection during the operation,so that the paravertebral muscles can be protected,which make the surgery more minimally invasive and the invasion of the operation further reduced.At the same time,compared with the lateral mass or pedicle screw of the atlas combined with axial pedicle screw fixation,the lateral mass or pedicle screw of the atlas combined with axial isthmus screw fixation can increase the anteroposterior and vertical distance between the heads of C1 and C2 screws due to the change of screw entry points,which can provide a wider operative space for the three dimensional reduction of atlantoaxial dislocation.However,since the axis is a transitional vertebra between the upper and lower cervical spine which has complexity and variability in anatomical structure,many scholars have limited understanding of this new technique.There are no unified standards for screw placement and surgical details,which are mostly based

关 键 词：颈椎疾病 脊柱中线 峡部 骨性标志 上颈椎 椎弓根螺钉 枢椎 发育不全 

分 类 号：R687.3[医药卫生—骨科学]