椎弓根螺钉植入技术的解剖学及影像学分析

Anatomic and imaging analysis of pedicle screw insertion technique

目的:就近年来国内外椎弓根螺钉植入技术方面的研究近况,探讨椎弓根螺钉植入技术的研究进展。资料来源:应用计算机检索Medline1959-01/2004-12相关椎弓根螺钉植入技术方面的文献,检索词“Spine,PedicleScrew,SpinalFusion”,并限定文章语言种类为English。同时检索CBM1986-01/2004-12相关椎弓根螺钉植入技术方面的文献,检索词为“脊柱,椎弓根螺钉,脊柱融合”,并限定文章语言种类为中文。资料选择:对资料进行初审,选取与椎弓根螺钉植入技术及脊柱融合相关的文献,并查找全文。纳入标准:①椎弓根螺钉植入技术的研究。②相关的解剖学的研究。③螺钉植入辅助技术方面的研究。排除标准:①畸形、肿瘤方面的文章。②内固定失败、螺钉强化等方面的文章。③综述文献、重复研究、Meta分析类文章。资料提炼:共收集到42篇关于椎弓根植入方面的研究,纳入27篇符合标准的文献。资料综合:经椎弓根内固定系统是三柱固定、三维矫形,具有较好的生物力学性能。其椎弓根螺钉植入主要包括定位、定向、控制深度三步,任何一步的失误将可能导致一系列严重的并发症。因此为了保证植入的螺钉沿着椎弓根轴心线到达椎体,使螺钉位于椎弓根内,国内外学者进行了相应的解剖学研究,同时也提出了许多相关的辅助和监测技术。结论:进一步提高椎弓根螺钉植入的准确性,尚值得深入研究。

OBJECTIVE： To probe into the progress of study on pedicle screw insertion technique according to the recent researches of pedicle screw insertion technique in the world. DATA SOURCES： A computer-based search of Medline for English articles related to pedicle screw insertion technique from January 1959 to December 2004 with the key words of ＂spine, pedicle screw, spinal fusion＂. Meanwhile, CBM were searched for Chinese literatures on pedicle screw insertion technique from January 1986 to December 2004 with the key words of ＂spine, pedicle screw, spinal fusion＂. STUDY SELECTION： Literatures were firstly searched, and full-text articles about pedicle screw insertion technique and spinal fusion were looked for. Accepting criteria： ① Research about pedicle screw insertion technique. ②Relative anatomical research. ③ Research about the assistant technique of screw insertion. Excluded criteria： ① Articles about deformity and tumor. ②Articles on failure of internal fixation and augmentation of screw. ③ Reviews, repetitve researches and articles of Meta analysis. DATA EXTRACTION： A total of 42 researches on pedicle insertion technique were collected, and 27 included articles were in accordance with the accepting criteria. DATA SYNTHESIS： Internal fixing system of pedicle vertebral was 3- column fixation and 3-diamension orthopedics, which had better nature of vitodynamics. Its pedicle screw insertion mainly included 3 steps of allocation, orientation and depth-control, any fault in any step would lead to severe complications. Therefore, in order to make sure the inserted screw reached the centrum along the core line of pedicle vertebral, the screw should be put inside the pedicle vertebral. Domestic scholars and scholars abroad had conducted corresponding researches on anatomy and raised some relative assistance and monitoring techniques at the same time. CONCLUSION： the accuracy of pedicle screw insertion is elevated and still needs further researching.