腰椎骨折治疗中置入螺钉内固定系统的安全性评价

Safety of screw internal fixation system in treatment of lumbar vertebral fracture

背景:腰椎骨折后经椎体椎弓根植入螺钉内固定技术在临床上应用越来越广泛,但其安全性及有效性仍存在争论。目的:评价腰椎骨折治疗中置入螺钉内固定系统的安全性及其并发症发生情况。方法:采用电子检索的方式,在万方数据库(http://www.wanfangdata.com.cn/)中检索2000-01/2011-12有关置入螺钉内固定系统治疗腰椎骨折的研究文章,关键词为"腰椎骨折,螺钉,内固定"。排除重复研究、普通综述或Meta分析类文章,筛选纳入31篇文献进行评价。结果与结论:置入螺钉内固定系统治疗腰椎骨折的不安全性主要存在于:错位固定、椎弓根定位错误、复位欠佳、骨折过度复位、神经损伤。内固定后并发症包括:螺钉断裂、连杆断裂、假关节形成、矫正度丢失、切口裂开。术者具有良好的脊柱解剖知识及脊柱外科手术经验,熟练掌握器材的性能及使用技术要求,椎弓根螺钉的准确定位及准确置入是内固定成功的关键;内固定后配带支具及扶拐功能锻炼,恰当的植骨技术,可减少断钉率及提高植骨融合率。由于椎弓根螺钉系统在力学结构上的合理性,加上在设计、材质、工艺及操作技巧的不断改进与完善,以及影像学技术及计算机导航系统的不断发展,其置入安全性将明显提高。

BACKGROUND：After fracture of lumbar vertebra,vertebral arch pedicle screw fixation has been widely used in clinic,but its safety and efficacy remains controversial. OBJECTIVE：To evaluate the safety and complication occurrence of screw internal fixation system in treatment of lumbar vertebral fracture. METHODS：We retrieved Wanfang Database（http：//www.wanfangdata.com.cn/） for articles concerning screw internal fixation system in treatment of lumbar vertebral fracture published from January 2000 to December 2011.The key words were ＂lumbar vertebral fracture,screw,internal fixation＂.Repetitive studies,common reviews or Meta analysis were excluded.A total of 31 articles were included. RESULTS AND CONCLUSION：The unreliability of screw internal fixation system for treating lumbar vertebral fracture mainly was：dislocation fixation,wrong vertebral arch pedicle location,poor reposition,excessive reposition of fracture,and nerve injury.Complications following internal fixation contained screw breakage,connecting rod breakage,prosthetic joint formation,rectification loss,and wound disruption.The operator should have good anatomic knowledge of spinal column and surgical experiences,fluently mastered equipment function and usage technique requirement.The exact location and implantation of vertebral arch pedicle screw are the key points of successful internal fixation.Usage of orthosis and crutches after internal fixation and correct bone graft technique could reduce screw breakage rate and elevate bone graft fusion rate.The implant safety would obviously elevate,because of rationality of mechanic structure of vertebral arch pedicle screw system,improvement of its design,material,artwork and operation skill,development of imaging technique and computer navigation system.