3D导板与机器人辅助腰椎皮质骨轨迹置钉技术研究进展

Advances in 3D Guide Plate and Robot-Assisted Lumbar Cortical Bone Trajectory Screw Placement Technique

随着全球人口老龄化加剧,脊柱退行性疾病患者合并骨质疏松症的发病率逐年增高。腰椎皮质骨轨迹置钉技术是解决骨质疏松患者螺钉松动有效方式之一,皮质骨轨迹螺钉比传统的椎弓根螺钉具有更好的生物力学性能。然而由于皮质骨轨迹置钉点偏内和置钉方向外展头倾角度更大缺乏明确解剖置顶点会增加腰椎皮质骨轨迹置钉手术难度。近年来,3D打印技术与骨科机器人辅助置钉技术的应用在提高骨质疏松患者皮质骨轨迹置钉精准度、增加皮质骨接触层数及减少小关节突关节侵犯率等方面发挥重要作用。本研究回顾国内外文献,对两种辅助置钉技术对腰椎皮质骨轨迹置钉的研究进行综述,同时对两种技术有新的认识和思考。

As the global population is aging, the incidence of combined osteoporosis in patients with degenerative spinal diseases is increasing every year. Lumbar cortical bone trajectory screw placement technique is one of the effective ways to address screw loosening in osteoporotic patients, and cortical bone trajectory screws have better biomechanical properties than conventional pedicle screws. However, the lack of a clear anatomical apex point increases the difficulty of lumbar cortical bone trajectory screwing due to the inward bias of the cortical bone trajectory screwing point and the greater adduction and cephalic tilt in the screwing direction. In recent years, the application of 3D printing technology and orthopaedic robot-assisted screw placement technology has been used to improve the accuracy of screw placement in cortical bone trajectories in osteoporosis patients, and it plays an important role in increasing the number of cortical bone contact layers and reducing the rate of small articular synovial joint invasion. This study reviews the national and international literature on two assisted nailing techniques for lumbar cortical bone trajectory placement and at the same time new insights and reflections on both technologies.