脊柱骨水泥强化螺钉技术的研究进展  

Research progress of spinal bone cement augmented screw techniques

作　　者：肖扬 张瑞[1] 阿卜力克木·买买提 王轶希 郭海龙[1] 帕尔哈提·热西提[1,2,3] Xiao Yang;Zhang Rui;Abulikemu·Maimaiti;Wang Yixi;Guo Hailong;Paerhati·Rexiti(Minimally Invasive Spine and Precision Orthopedics,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Xinjiang Clinical Research Center for Orthopedics,Urumqi 830054,China;Key Laboratory of High Incidence Disease Research in Xinjiang(Xinjiang Medical University),Ministry of Education,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院脊柱微创及精准骨科,乌鲁木齐830054 [2]新疆医科大学新疆地区高发疾病研究教育部重点实验室,乌鲁木齐830054 [3]新疆骨科疾病临床医学研究中心,乌鲁木齐830054

出　　处：《中华骨科杂志》2025年第5期310-316,共7页Chinese Journal of Orthopaedics

基　　金：“天山英才”医药卫生高层次人才培养计划基金(TSYC202301B026);新疆维吾尔自治区杰出青年科学基金(2021D01E29)。

摘　　要：骨质疏松患者固定强度差以及螺钉术后发生松动、移位,是脊柱疾患应用椎弓根螺钉固定术后的常见问题,一般需对螺钉进行加固和翻修。骨水泥强化技术在不改变螺钉直径、长度和材质的情况下,能稳固增强内固定的稳定性,提高手术疗效。临床广泛应用的骨水泥类型包括聚甲基丙烯酸甲酯和磷酸钙骨水泥及其复合系列,其强化方式主要分为钉道骨水泥强化和空心侧孔螺钉强化两类。钉道骨水泥强化通过在椎弓根钉道预先注入骨水泥后再置入螺钉,可增强内固定稳定性。但钉道骨水泥强化存在骨水泥分布难以精确控制、易渗漏等潜在风险。空心侧孔螺钉强化通过优化骨水泥注入方式和螺钉设计,较钉道骨水泥强化提高了螺钉的稳定性,还可有效降低骨水泥渗漏等并发症的发生率,尤其在初次和翻修手术中表现优良。针对重度骨质疏松及椎弓根钉道受损需翻修的患者,骨水泥强化皮质骨轨迹螺钉技术拥有较好的力学性能,且通过调整置钉路径,可能避开椎体中央静脉,减少骨水泥渗漏栓塞风险,但尚需进一步研究证实。随着机器人辅助置钉技术的快速发展,脊柱骨水泥强化螺钉技术的精准性和安全性得到提升、手术创伤减小、并发症风险降低。未来基于患者骨质状况可更科学、客观地选择适宜的螺钉类型和置钉技术,进一步减少并发症,以个性化治疗为原则,不断提升患者疗效与预后,为患者带来更加安全、有效的治疗方案。The frequent challenges encountered in spinal surgeries utilizing pedicle screws for osteoporotic patients include inadequate fixation strength and postoperative screw loosening or displacement,often requiring reinforcement or surgical revision.The bone cement-augmented technique,without altering the diameter,length,or material of the screws,can solidly enhance the stability of internal fixation and improve surgical efficacy.The bone cement types that are widely applied in clinical practice encompass Polymethyl Methacrylate(PMMA),Calcium Phosphate Cement(CPC),and their composite series.The bone cement reinforcement techniques are mainly divided into two categories:bone cement augmentation within pedicle screw pathway and hollow lateral-hole screw reinforcement.The technique of pedicle screw pathway bone cement augmentation significantly enhances the stability of internal fixation by pre-injecting bone cement into the pedicle screw pathway before inserting the screw.However,it poses potential risks such as difficulty in precisely controlling the distribution of bone cement and susceptibility to leakage.In comparison,hollow lateral-hole screw augmentation,through the optimization of bone cement injection techniques and screw design,not only augments screw stability but also effectively decreases the incidence of complications such as bone cement leakage,especially exhibiting outstanding performance in both primary and revision surgeries.For patients with severe osteoporosis or those requiring revision surgery due to compromised pedicle screw tracts,the bone cement-augmented cortical bone trajectory(CBT)exhibits favorable mechanical properties.By adjusting the screw placement pathway,it may potentially avoid the central venous sinus of the vertebra,thereby reducing the risk of bone cement leakage and embolism.However,further research is needed to confirm these findings.With the rapid development of robot-assisted pedicle screw placement technology,the precision and safety of spinal screws augmented with bone cement

关 键 词：脊柱疾病 骨螺丝 椎弓根钉 骨质疏松 骨水泥强化技术 

分 类 号：R687.3[医药卫生—骨科学]