经皮椎弓根钉内固定术治疗胸腰椎骨折的研究进展

Progress in the treatment of percutaneous pedicle screw internal fixation for thoracolumbar fracture

胸腰椎骨折是骨科的常见骨折之一,传统后路开放椎弓根钉内固定术临床效果确切,但存在手术创伤大、出血多、住院时间长、术后并发症多等缺点,易出现术后顽固性腰背痛。随着脊柱外科技术的发展,经皮椎弓根钉内固定术因其创伤小、出血少、住院时间短、即刻固定效果好、对脊柱后方结构损伤较小、术后疼痛缓解明显、感染率低等优点,被广泛应用于治疗胸腰椎骨折;且随着手术器械不断改进、辅助手段持续丰富,其临床效果也不断提高。但微创手术有其局限性,须严格掌握适应证。本文就经皮椎弓根钉内固定术的解剖学基础、发展沿袭、适应证及禁忌证、并发症作一综述,以期为临床胸腰椎骨折的治疗提供参考。

Thoracolumbar fracture is one of the most common fractures in orthopedics.Traditional posterior open pedicle screw internal fixation has definite clinical curative effect,but there are many shortcomings,such as large surgical trauma,excessive blood loss,long hospital stay and a variety of postoperative complications.Also,postoperative intractable low back pain has been reported.As the development of spinal surgery techniques,percutaneous pedicle screw internal fixation has been widely used in the treatment of thoracolumbar fracture due to its advantages of less trauma,less blood loss,shorter hospital stay,better immediate fixation effect,less damage to the posterior spinal structure,more significant postoperative pain relief,lower infection rate and so on.And with the continuous improvement of surgical instruments and enrichme nt of auxiliary means,its clinical effect is also improving.However,minimally invasive surgery has its limitations and the indications must be strictly controlled.This article reviews the anatomical basis,development,indications,contraindications and complications of percutaneous pedicle screw internal fixation,in order to provide a reference for the clinical treatment of thoracolumbar fracture.