颈椎椎弓根螺钉置入内固定:影像学测量与临床应用

Imaging measurement and clinical application of pedicle screw internal fixation

目的:评价椎弓根螺钉置入内固定技术修复脊柱骨折影像学测量参数和临床应用情况,寻找合理的技术方法。方法:采用电子检索的方式,在万方数据库、Medline数据库中检索2000-01/2010-06有关椎弓根螺钉置入内固定技术应用于脊柱骨折的研究文章,关键词为"颈椎椎弓根,螺钉,置入参数,cervical pedicle,cervical pedicle,set screw,parameter"。排除重复研究、普通综述或Meta分析类文章,筛选纳入20篇文献进行评价。结果:椎弓根螺钉大小的选择应依据术前影像学测量所得到的事实参数,选择合适的螺钉。通过椎弓根螺钉贯穿前、中、后三柱,对整个脊柱都有固定作用,而且两侧椎弓根相互成近似直角,这种立体结构是后路椎弓根螺钉置入内固定具有较强的抗侧弯和轴向扭转作用,此即颈椎椎弓根螺钉固定的生物力学基础。术前传统的普通X射线片测量手段已经被目前的CT三维扫描替代。随着计算机和材料工程技术的发展,越来越精细的三维成像技术辅助了内固定的发展。结论:虽然计算机导航系统指导的颈椎置钉效果较好,但在国内尚难普遍开展应用,这就要求临床医生有丰富的置钉经验,选择合适的置钉方法和完善的术前计划减少并发症。

OBJECTIVE：To evaluate imaging measurement parameters and clinical application of pedicle screw internal fixation technique spinal fracture and to search an appropriate technique. METHODS：A computer-based online search of Wanfang database,Medline database was performed for articles published between January 2000 and June 2010 related to pedicle screw internal fixation technique for spinal fracture with the key words ＂cervical pedicle,screw,implantation parameter＂ in Chinese and English,respectively. Repetitive,review and Meta analysis wer excluded. Finally,20 articles were included. RESULTS：Size of pedicle screws is selected according to parameters measured by preoperative imaging. The pedicle screws penetrate anterior,middle and posterior spine to fix the entire spinal cord. Moreover,bilateral pedicles form a right angle,which provides strong lateral bending and axial torsion support,i.e. biomechanical basis of cervical pedicle screw fixation. Preoperativ X-ray measurement has been replaced by CT three-dimensional scanning. With developing computer and material engineering techniques,three-dimensional imaging assists internal fixation. CONCLUSION：Although computer-navigation system guided cervical screw implantation exhibits good effect,it is not extensive used domestically. Appropriate screw implantation methods,accurate preoperative planning,and experienced screw implantatio operation can reduce complications.