非融合内固定治疗腰椎退行性疾病的临床应用

Clinical application of non-fusion internal fixation in treating lumbar degenerative disease

背景:脊柱融合术被广泛使用于腰椎退行性疾病的治疗。经过大量的临床观察,融合后仍然存有腰部活动受限、脊柱动力学改变、邻近节段加速退变等一系列继发腰椎不稳以及椎管狭窄等症状的出现。目的:综述非融合内固定治疗腰椎退行性疾病的临床应用。方法:应用计算机检索1997-01/2009-12PubMed数据库(http://www.ncbi.nlm.nih.gov/PubMed)相关文章,检索词为"lumbarspinalfusion,destabilization,non-rigidfixation",并限定文章语言种类为English。共检索到文献84篇。结果与结论:腰椎融合术仍是目前治疗腰椎不稳的标准方法,但腰椎融合率与临床满意率并不呈正比,而且腰椎融合有导致相邻节段加速退变的潜在可能。尽管目前还没有评价固定椎体间活动范围的量化标准,但理想的动态固定应能保证正常的脊柱稳定性,并且最大限度地恢复节段间的活动度。近年来,国内外已进行了大量非融合固定技术的基础和临床研究。非融合技术治疗腰椎退行性疾病是一种更符合生理需要的手术方法,可以减少一系列传统融合技术所带来的不良并发症的发生。这种方法将在新的分阶段式外科策略中扮演非常重要的角色,从而避免退变椎间节段的最终融合。

BACKGROUND： The spinal fusion is used extensively in the treatment of the lumbar degenerative disease. But there were a series of the symptoms such as lumbar destabilization, change of lumbar dynamics, accelerated degeneration of adiacent segment and spinal stenosis by massive clinical observations. OBJECTIVE： To review the clinical application of non-fusion internal fixation in treating lumbar degenerative disease. METHODS： The PubMed database was researched by computer to search documents published between January 1997 and December 2009 with key words of ＂lumbar spinal fusion, destabilization, non-rigid fixation＂ in English. Totally 84 papers were selected. RESULTS AND CONCLUSION： Lumbar spinal fusion is still the standard method for treating lumbar instability, however, lumbar spinal fusion may accelerate the degeneration of adjacent segment, and the lumbar fusion rate was not proportional to clinical satisfactory rate. There is no quantitative standard for evaluating range of intervertebral motion, but the ideal dynamical fixation should guarantee the spinal stabilization and recover the range of motion to the largest extent. Recently, a large number of studies concerning non-fusion fixation technology have been performed in China and abroad. Non-fusion internal fixation is a surgery method for treating lumbar degenerative disease which meets physiological need and reduces a series of harmful complications. This method can avoid fusion of degenerative segment.