腰椎关节突关节融合:从植骨融合到螺钉和融合器的应用

Lumbar zygapophysial joint fusion:From bone graft to screws and fusion cages

背景:腰椎关节突关节是脊柱后柱的重要结构,其固定与融合在腰椎后路手术被广泛应用。目的:阐述了各种腰椎关节突关节融合技术的优缺点和疗效。方法:应用计算机检索PubMed数据库、CNKI数据库中有关腰椎关节突关节融合方法的文献。结果与结论:传统的关节突关节融合方法为关节突关节V形开槽,然后植入松质骨,不需要作大范围的剥离,创伤小,所需植骨量较少,融合率高,缺点是即刻的稳定性较差。经关节突关节螺钉固定联合横突间融合可以提高植骨融合率,但存在融合失败、术后症状缓解不明显、螺钉松动和断裂、硬膜撕裂、螺钉穿刺到椎管引起神经损伤等并发症。圆柱体嵌入椭圆体的融合器有利于融合器与关节面充分的接触,同时提高了融合器的稳定性和抗移位能力。目前对腰椎关节突关节融合的研究远没有对后外侧融合的研究那么充分,系统的生物力学研究和中远期临床疗效及并发症的研究有待深入研究。

BACKGROUND：Lumbar zygapophysial joint is an important post-column structure,of which the fixation and fusion has been relatively widely used in the lumbar posterior surgery.OBJECTIVE：To describe the advantages,disadvantages and efficacy of different fusion technologies of lumbar zygapophysial joint.METHODS：PubMed and CNKI databases were searched for the literatures about lumbar zygapophysial joint fusion.RESULTS AND CONCLUSION：The traditional fusion method of zygapophycial joint is to make V slot and then to implant cancellous bone,which does not need wide dissection,so it has the advantage of small trauma,less plant and high fusion rate,while it has the defect of poorer immediate stability as well.The method of using zygapophysial joint screws can improve fusion rate of bone graft,but it has the complications of fusion failure,less obvious postoperative symptoms ease,screw loose and fracture,hard film rent and nerve damage caused by screw puncture to sedation.And the usage of oval fusion cage is beneficial to the full contact of fusion cage and joint surface,and then to improve the stability and shift resistance ability of the fusion cage.At present,the research of lumbar zygapophysial joint fusion is far less than that of the posterolateral fusion,so it is important to systematically study the biomechanics,clinical curative effects and complications much further.