下颈椎后路椎弓根钉置钉:人工智能发展将如何提高治疗效果

Screw placement in posterior route pedicle on subaxial cervical spine:how to improve the therapeutic effect with the development of artificial intelligence

背景:下颈椎椎弓根钉因具有优良的生物力学优势而广泛用于创伤、肿瘤及畸形导致的多种颈椎疾病。如何提高置钉准确性,减少术后并发症,一直是下颈椎椎弓根钉技术研究的热点。目的:查阅国内外相关文献,综述近年国内外有关下颈椎椎弓根钉技术的相关解剖形态学特点、下颈椎后路椎弓根钉生物力学特点及其置钉技术的研究,分析各置钉技术的优点与不足。方法:分别以"cervical,pedicle"及"颈椎,椎弓根"为检索词检索PubMed、Web of Science及CNKI、万方等数据库中的相关文献,中文检索2015年1月至2020年12月发表的相关文献,英文检索近5年发表的相关文献。最终纳入文献52篇,其中中文文献22篇,英文文献30篇。结果与结论:(1)对于椎弓根的皮质厚度与强度而言,内侧壁均高于外侧壁;从C3-C7椎弓根的外展角逐渐减小,而椎弓根的形态则类似于长圆形;椎弓根上缘距其上位神经根从C3-C7逐渐增大,椎弓根下缘距其下位神经根从C3-C7逐渐减小,而椎弓根前外侧壁紧贴椎动脉,椎弓根前内侧壁紧贴硬膜外窦;(2)椎弓根的上、下、外侧三侧壁的突破力均小于内侧壁;在抗拔出力方面,直接拔出力椎弓根钉优于椎间孔钉与侧块螺钉,疲劳拔出力椎弓根钉与椎间孔钉优于侧块螺钉;(3)目前下颈椎后路椎弓根钉置钉技术主要包括徒手置钉、计算机导航辅助置钉、3D打印导板辅助置钉、手术机器人辅助置钉等,但各种技术流派均有一定不足,今后一段时间内徒手置钉技术仍将是下颈椎椎弓根钉置钉技术的主流,随着技术水平的提升和配套人工智能辅助科技设备的完善,人工智能辅助置钉技术将是未来的发展方向。

BACKGROUND:Because of its excellent biomechanical advantages,pedicle screw of subaxial cervical spine is widely used in various cervical spine diseases caused by trauma,tumors and deformities.How to improve the accuracy of nail placement and reduce postoperative complications has been hotspots in the research of the placement technology of the pedicle screw of subaxial cervical spine.OBJECTIVE:To review relevant domestic and foreign articles,to review the related anatomical characteristics of the placement technology of the pedicle screw of subaxial cervical spine,the biomechanical characteristics of pedicle screw of subaxial cervical spine and the research on the screw placement technology in and outside China,and to analyze the advantages and disadvantages of each placement technology.METHODS:Relevant articles in PubMed,Web of Science,CNKI,Wanfang and other databases were searched using"cervical,pedicle"in English,and"cervical vertebrae,pedicle"in Chinese as search terms.Related Chinese articles published from January 2015 to December 2020 and related English articles published in the past 5 years were searched.Finally,52 articles were included,including 22 Chinese articles and 30 English articles.RESULTS AND CONCLUSION:(1)Regarding the thickness and strength of the cortex,the inner wall of the pedicle was higher than that of the outer wall.The abduction angle of the pedicle gradually decreased from C3-C7.The shape of the pedicle was similar to an ellipsoid.The distance between the upper edge of the pedicle and the upper nerve root gradually increased from C3-C7,and the distance between the lower edge of the pedicle and the inferior nerve root gradually decreased from C3-C7.The anterior lateral wall of the pedicle was close to the vertebral artery;and the anterior medial wall of the pedicle was close to the epidural sinus.(2)The penetrating force of the inner wall of the pedicle was greater than the other three side walls.In terms of direct extraction force,pedicle screws were superior to intervertebral foraminal screws and lateral mass screws.In terms of fatigue extraction force,pedicle screws and intervertebral foraminal screws were better than lateral mass screws.(3)At present,screw placement in posterior route pedicle on subaxial cervical spine mainly included freehand screw placement,computer-assisted screw placement,3 D printing guide-assisted screw placement,and surgical robot-assisted screw placement.However,various screw placement techniques have certain drawbacks.In the future,freehand screw placement technology will still be the mainstream of the subaxial cervical pedicle placement technology.With the improvement of technical level and the support of artificial auxiliary equipment,artificial intelligence assisted screw placement technology will become the future development direction.