颈椎前路椎弓根螺钉在颈椎不稳疾病应用的研究进展

Progress on clinical application of anterior cervical pedicle screw fixation for instable cervical spine disease

颈椎不稳疾病需要手术来重建其稳定性。以往而言,手术方式可分为前路与后路两种,但各自有各自的缺点。前路椎体螺钉的失败率较高,有时需要再次手术;而后路椎弓根螺钉、侧块螺钉、关节突关节螺钉的创伤较大,导致患者住院时间较长。一般的颈椎不稳疾病,根据疾病所在的位置,单用前路或者后路就可以达到稳定的效果。但是,对于单节段的三柱损伤、需要多节段的椎体次全切除术和椎间盘摘除术的疾病,单一的前路或后路往往不能达到预期的牢固稳定效果。同时,联合应用前后路又有其更突出的缺点:如手术时间延长、手术损伤更大、感染风险增加等等。近些年来,颈椎前路椎弓根螺钉作为一种新近提出的颈椎固定技术。它的生物力学特性、形态学的可行性、抗拔出力的强度、影像学特点及新兴置钉技术已经有了相关的实验室及临床研究。因其重建的牢固稳定性、良好的力学特性和患者的满意疗效得到了较多学者的认可。虽然颈椎前路椎弓根螺钉技术已经被运用于临床上,但它的长期临床效果还需待进一步明确。尽管如此,其创新性的提出,将为广大医师同仁为治疗颈椎不稳疾病提供新的解决思路。

Instability of the cervical spine disease requires surgery to restore stability. In the past,surgical methods were divided into two kinds of anterior and posterior. But each has its own disadvantages ：anterior vertebral screw has a higher failure rate,sometimes need a second operation;and posterior pedicle screw,lateral mass screw and facet joint screw may make greater trauma,lead to longer hospitalization. For general instable cervical spine disease,according to the location of the disease,only with the anterior or posterior approach can achieve a stable effect. However,it often fails to achieve the desired stability with only anterior or posterior approach for the three column injury of single segment,the disease need for multi-segment corpectomy and discectomy. Meanwhile,combined with the anterior and posterior have more obvious disadvantages ：such as prolonged operation time,greater surgical injury,increased risk of infection and so on.In recent years,anterior transpedicular screw（ATPS） as a new technique was used for cervical spine fixation. Its laboratory and clinical studies have been conducted about biomechanical properties,morphological feasibility,pull-out strength,radiological features and new technology for inserting screws. Because of its strong stability,perfect mechanical properties and the satisfactory results of patients,which has been recognized by many scholars. Although this technique has been used in clinical practice,Its long-term clinical effect needs to be further clarified. Even so,the innovative proposal will provide a new thread for the majority of doctors and colleagues in treating unstable cervical disease.