脊柱植入物的临床应用

Clinical application of spinal implants

随着材料学和生物力学发展,传统的脊柱内固定方法不断改进,新型内固定器械不断涌现,新的内固定器械在临床应用前应该在实践中不断完善,并在脊柱退行性疾病、脊椎肿瘤、创伤、感染等手术中得到了广泛的应用。其目的是解除脊髓压迫,重建脊柱的正常序列和骨性融合,内固定的优势就在于矫正畸形、促进融合而利于早期康复。内固定对前路手术融合率的影响与前路手术的疗效及减压是否彻底、椎间是否融合有关。研究证实,螺钉的直径、几何形状、螺钉位置和进钉技术以及椎体的骨质状况与失败的发生直接相关。在脊柱重建过程中,移植骨常使用自体髂骨块和腓骨。但由于移植骨的获取而导致的并发症,包括感染、血肿形成、神经损伤、髂骨骨折、腹腔内容物疝,以及长期的供区疼痛,为避免供区并发症的发生,常采用同种异体骨和钛网取代自体骨移植,但同种异体骨移植又容易有融合率低和疾病传播的风险,所以钛网植骨作为一种新的置入方式逐步发展起来。

With development of material science and biomechanics, traditional spinal internal fixation has been improved. Novel fixation device is developed and modified, and has been widely used in spinal degenerative diseases, spinal tumor, trauma and infection to remove spinal compression and reconstruct spinal sequence and bony fusion. Internal fixation corrects deformity, promotes fusion and benefit early rehabilitation. The influence of internal fixation on fusion rate after anterior approach surgery is related to effect of anterior approach surgery, compression results and intervertebral fusion. Studies have demonstrated that screw diameter, geometry, screw position, screw entry technique and vertebral bone situation are directly related to the failure of surgery. During spinal reconstruction, autologous lilac and fibular bones are frequently used as bone graft. However, harvest of bone grafts atways induce complications, such as infection, hematoma, nerve injury, iliac fracture, abdominal cavity content hernia and donor area pain for a long period of time. Bone allograft and Ti-mesh are commonly used to replace autograft to avoid complications. Bone allograft has low union rate and risk of propagation of disease, so Ti-mesh bone has been developed gradually.