脊柱脊髓损伤的修复重建研究进展

ADVANCEMENT IN THE REPAIR AND RECONSTRUCTION OF THE INJURED SPINE AND SPINAL CORD

目的阐述脊柱、脊髓损伤最新研究及治疗进展。方法广泛查阅文献,并结合研究及临床经验,总结近几年脊柱、脊髓损伤的研究动向及临床应用结果。结果后路寰枢椎固定技术由既往的侧块关节直接螺钉内固定术发展到今天较为常用的寰枢椎椎弓根或侧块螺钉相组合的钉板、钉棒内固定技术。经口咽入路寰枢椎复位钢板固定术能较好解决难复性环枢椎脱位的问题。胸腰椎骨折的手术入路、固定节段、融合方式等目前仍没有统一的标准,只要条件允许,前路和后路手术均能达到有效减压和稳定重建的目的。单节段骨折固定术较既往的跨节段固定术有一定优势。内窥镜辅助下或影像介导下的脊柱诊疗技术在我国逐渐开展。对治疗顽固疼痛性骨质疏松性压缩骨折患者,国内紧跟国外潮流及时开展经皮椎体成形术和后凸成形术,以重建椎体高度,修复椎体稳定性,改善症状,提高生活质量。相关的基础和临床研究使人们对急性脊髓损伤的药物治疗有了重新认识,而生物学治疗方法为神经的修复再生提供了新的思路,其中细胞移植和基因疗法是极有前景的治疗策略。结论随着脊柱外科的飞速发展,脊柱脊髓损伤的修复重建取得了长足的进步。

Objective To investigate the latest research and the therapeutic development in the injuries to the spine and spinal cord. Methods Literature concerned was reviewed, combined with our own research and clinical experience, to summarize the trend of the researches and their clinical application in the treatment of the injured spine and spinal cord. Results The posterior approach atlantoaxial stabilization technique changed the conventional wiring technique into the transarticular screw fixation to the plate and pedicle or the lateral mass screw fixation technique. The clinical application of the transoralpharyngeal atlantoaxial reduction plate fixation technique showed a good effect on the reduction of atlantoaxial dislocation. However, there were no unified criteria for selection of the surgical approach, fixation level, and fusion mode in the treatment of thoraeolumbar spinal fractures. Under optimal conditions, both the anterior and the posterior approaches could achieve good clinical effects on decompression and spinal reconstruction. The single level fixation technique showed some advantages in treating certain types of thoracolumbar spinal fractures when compared with the traditional cross-sectional fixation. The endoscopy-assistant and image-guiding spinal intervention techniques were evolved in China during these years. In the treatment of the obstinate painful osteoporotic vertebral compressive fracture, percutaneous vertebroplasty and kyphoplasty achieved good results in the pain relief and spinal reconstruction. Numerous basic and clinical researches have given us a further understanding of the medical protection of acute spinal cord injury, and biological treatments have given us new ideas on neural reparation and regeneration. Cell transplantation and gene therapy have become the most promising treatment strategies in this field. Conclusion With the rapid development of spine surgery, the repair and reconstruction of the injured spine and spinal cord made a great stride in the recent years.