腰椎融合术中椎弓根螺钉损伤关节突关节的研究进展

Research progress of facet joint violation by pedicle screw in lumbar interbody fusion

目的 探讨腰椎融合术中椎弓根螺钉损伤关节突关节的生物力学、发生率及相关影响因素的研究进展.方法 在PubMed、Springerlink、Medline、CNKI、万方数据等数据库中,以＂腰椎融合术、椎弓根螺钉、关节突关节损伤＂和＂lumbar interbody fusion、pedicle screw、facet joint violation＂为关鍵词,检索2003年1月-2015年12月有关腰椎融合术中椎弓根螺钉损伤关节突关节的相关研究成果,针对椎弓根螺钉损伤关节突关节的生物力学、发生率及相关影响因素的研究进行分析总结.结果;关节突关节是维持脊柱运动节段稳定的重要结构,其损伤可导致关节突关节挛缩、僵硬及骨性关节炎,从而加速邻近节段退变的发生.手术创伤是造成关节突关节损伤的重要因素,尤其是以术中植入椎弓根螺钉内置物损伤关节突关节为主.无论是开放置钉还是微创置钉,螺钉损伤关节突关节的发生率均较高.影响椎弓根螺钉损伤关节突关节的因素包括年龄、性别、体质量、融合节段、融合数量、手术方式、术中CT导航、置钉方位、置钉方法和螺钉类型等.结论;关节突关节损伤继而增生退变是导致邻近节段退变的重要危险因素,无论是开放还是微创置入椎弓根螺钉均可增加关节突关节损伤的发生,因此外科医师在置钉时需要注重关节突关节的保护,规避不良置钉影响因素.

Objective To review and summarize the research progress on biomechanics, incidence and influencing factors of facet joints violation by pedicle screw in lumbar interbody fusion.Methods The researches related to facet joint violation by pedicle screw were searched in Pubmed, SpringerLink, Medline, CNKI and Wanfang database from January 2003 to December 2015 by using ＂lumbar interbody fusion, pedicle screw, facet joint violation＂ as key words.Results Facet joint was an important structure for stability of lumbar spine, injury could lead facet joint contracture, stiffness and osteoarthritis, which eventually accelerated the incidence of adjacent segment degeneration.Surgical trauma was an important factor causing the facet joint violation, especially the insertion of pedicle screw in operation.Facet joint had a higher incidence of injury in both open and minimally invasive pedicle screw insertion.The factors affecting pedicle screw damage facet joints included： age, sex, weight, fusion segment, fusion number, operation method, intraoperative CT navigation, and so on.Conclusions Facet joint violation is an important risk factor which leads to adjacent segment degeneration.Insertion of pedicle screw in operation is an important factor causing the facet joint violation in both open and minimally invasive surgery.Surgeons should pay more attention to the facet joints protection in lumbar fusion surgery, especially in the insertion of pedicle screws.