胸腰椎椎弓根螺钉置入技术的比较分析与展望

Pedicle screw fixation for thoracic and lumbar diseases: a comparative analysis and prospects

背景:钉棒系统内固定是目前外科治疗胸腰椎疾患的主流术式,椎弓根螺钉的准确置入是此技术的关键,如何提高置钉精确度、减少二次置钉,是目前研究的热点。目的:比较各种椎弓根螺钉置入方法的优劣势及其临床应用价值。方法:以"Pedicle screw fixation,free-hand technique,3D-printing technology,computer navigation technology,clinical application prospect"为英文检索词,以"椎弓根螺钉固定术,徒手置钉技术,3D打印技术,计算机导航技术,临床应用展望"为中文检索词,检索至2016年5月为止Pub Med数据及CNKI中国期刊全文数据库,纳入内容为椎弓根螺钉置入治疗胸腰椎脊柱疾病的临床研究,排除重复性文献。收集目前临床已经开展且较为前沿的置钉技术,从其可行性、普及性、实用性等方面对各种技术进行系统评价。结果与结论:(1)以计算机辅助手术导航系统和3D打印技术为代表的新型方法是目前研究的热点,但仅适用于少数椎弓根先天畸形、解剖变异或病变较为复杂的病例;(2)徒手置钉技术仍是目前主流,是每一位脊柱外科医生必须掌握的基本技能;(3)徒手置钉技术仍是目前临床运用最为广泛的方法,应用时应注意完善术前规划、实施个体化置钉。

BACKGROUND： Pedicle screw fixation is mainly used to treat thoracolumbar disorders, and accurate placement is the key to success; thereafter, how to improve the accuracy of placement and reduce the secondary nailing is an issue of concern.OBJECTIVE： To compare the advantages and disadvantages of various pedicle screw placement methods and their application value.METHODS： CNKI and PubMed databases were retrieved for clinical research concerning the pedicle screw fixation for thoracolumbar disorders published before May 2016 using the keywords of ＂pedicle screw fixation, free-hand technique,3D-printing technology, computer navigation technology, clinical application prospect＂ in English and Chinese,respectively. The repetitive literatures were excluded, and the advanced pedicle screw technologies were collected and evaluated in views of feasibility, universality and practicability.RESULTS AND CONCLUSION： （1） Computer-assisted navigation system and three-dimensional printing technology are the focus of research, but only applied in the treatment of pedicle congenital malformations or complicated cases. （2） Free-hand technique is still the most widely used, which is the essential skills that surgeons must master. （3） Traditional technology is still the mainstream in clinic, so improved preoperative planning, and individualized scheme are needed.