下颈椎椎弓根螺钉固定的研究热点与进展
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摘要
背景:下颈椎椎弓根螺钉固定能够贯通脊柱前中后三柱,有效恢复颈椎矢状序列、提供坚强内固定和高融合率,是颈椎生物力学上最稳定的内固定。目的:通过查阅国内外相关文献,对下颈椎椎弓根螺钉固定相关的椎弓根解剖结构、置钉固定的生物力学性能、3D打印技术辅助置钉应用等方面进行概括。方法:第一作者应用计算机检索1990年1月至2017年1月Pub Med数据库、中国期刊全文数据库有关下颈椎椎弓根螺钉固定的文章,英文检索词为"lower cervical,pedicle screw,3D printing technology",中文检索词为"下颈椎,椎弓根螺钉,3D打印技术"。总计收集文献193篇,排除重复性研究、个案报道及Meta分析类文章。结果与结论:(1)最终纳入52篇文献进行综合分析;(2)综述结果显示,尽管下颈椎椎弓根螺钉固定有很高的风险,只要进行充分的术前个性化评估和术中精准的置钉技术,可将其风险至最低甚至避免,具有很高的临床应用价值。
BACKGROUND: The lower cervical pedicle screw fixation is the most stable internal fixation of the cervical spine in biomechanics, which can penetrate the anterior, middle and posterior columns of the spine, effectively restore the sagittal sequence of the cervical spine, provide strong internal fixation and high fusion rate. OBJECTIVE: To review the relevant information of the anatomical structure of lower cervical pedicle, the biomechanical property of screw fixation, and three-dimensional printing technology-assisted screw placement at home and abroad. METHODS: Pub Med and CNKI databases were searched for the articles concerning lower cervical pedicle screw fixation from January 1990 to January 2017. The key words were "lower cervical, pedicle screw, 3 D printing technology" in Chinese and English, respectively. Totally 193 articles were researched, and the repetitive research, case report and meta-analysis were excluded. RESULTS AND CONCLUSION:(1) Finally 52 eligible articles were enrolled for result analysis.(2) Although it has a very high risk to fix lower cervical pedicle screw, the risk could be minimized or avoided through fully individualized evaluation preoperatively and precise fixation intraoperatively. So the lower cervical pedicle screw fixation has high clinical value.
BACKGROUND: The lower cervical pedicle screw fixation is the most stable internal fixation of the cervical spine in biomechanics, which can penetrate the anterior, middle and posterior columns of the spine, effectively restore the sagittal sequence of the cervical spine, provide strong internal fixation and high fusion rate. OBJECTIVE: To review the relevant information of the anatomical structure of lower cervical pedicle, the biomechanical property of screw fixation, and three-dimensional printing technology-assisted screw placement at home and abroad. METHODS: Pub Med and CNKI databases were searched for the articles concerning lower cervical pedicle screw fixation from January 1990 to January 2017. The key words were "lower cervical, pedicle screw, 3 D printing technology" in Chinese and English, respectively. Totally 193 articles were researched, and the repetitive research, case report and meta-analysis were excluded. RESULTS AND CONCLUSION:(1) Finally 52 eligible articles were enrolled for result analysis.(2) Although it has a very high risk to fix lower cervical pedicle screw, the risk could be minimized or avoided through fully individualized evaluation preoperatively and precise fixation intraoperatively. So the lower cervical pedicle screw fixation has high clinical value.
引文
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[30]朱道平,刘克斌,黄奎.后路减压固定治疗伴椎间盘突出的下颈椎骨折脱位[J].骨科,2014,5(2):98-101.
[31]段扬.下颈椎后路内固定技术的有限元比较研究[D].南方医科大学,2011.
[32]孙程帅,李雷,孟伟宁.颈椎后路椎弓根螺钉内固定术治疗脊髓型颈椎病患者的疗效分析[J].沈阳医学院学报,2016,18(4):245-247.
[33]李书纲,盛林,赵宏,等.计算机导航技术在脊柱椎弓根钉固定中的应用[J].中华医学杂志,2009,89(11):736-739.
[34]Hwang TJ,Kiang C,Paul M.Surgical applications of3-dimensional printing and precision medicine.JAMA.2015;141(4):305-306.
[35]Giesel FL,Hart AR,Hahn HK,et al.3D reconstructions of the cerebral ventricles and volume quantification in children with brain malformations.Acad Radiol.2009;16(5):610-617.
[36]王远政,田晓滨,刘洋,等.Mimics及颈椎模型用于下颈椎椎弓根个体化置钉的应用研究[J].第三军医大学学报,2012,34(15):1543-1547.
[37]Guarino J,Tennyson S,Mc Cain G,et al.Rapid prototyping technology for surgeries of the pediatric spine and pelvis:benefits analysis.J Pediatr Orthop.2007;27(8):955-960.
[38]Gelalis ID,Paschos NK,Pakos EE,et al.Accuracy of pedicle screw placement:a systematic review of prospective in vivo studies comparing free hand,fluoroscopy guidance and navigation technique.Eur Spine J.2012;21(2):247-255.
[39]房岩,孙刚,丛茜,等.仿生材料学研究进展[J].农业机械学报,2006,37(11):163-167.
[40]王镓垠,柴磊,刘利彪,等.人体器官3D打印的最新进展[J].机械工程学报,2014,50(23):119-127.
[41]Langer R.Tissue engineering:perspectives,challenges,and future directions.Tissue Eng.2007;13(1):1-2.
[42]宋柯,付茂庆,孔祥雪,等.生物安全性的下颈椎后路经椎弓根固定的个性化导航模板研究[J].中国临床解剖学杂志,2012,30(5):509-512.
[43]张振辉,王庆德,梅伟,等.快速成型个体化导航模板辅助颈椎椎弓根螺钉的置入[J].中国组织工程研究,2017,21(3):340-344.
[44]宁金沛,吴卫东,覃求,等.3D打印个体化导航模板在胸椎和颈椎椎弓根螺钉植入的临床应用[J].实用骨科杂志,2015,21(5):385-389.
[45]Bozkus H,Ames CP,Chamberlain RH,et al.Biomechanical analysis of rigid stabilization techniques for three-column injury in the lower cervical spine.Spine.2005;30(8):915-922.
[46]白宇哲,李长树,徐楚,等.数控机床技术在下颈椎个体化导向模板制作中的应用[J].中国临床解剖学杂志,2015,33(3):284-287.
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[51]曹珺,代耀军,何飞.下颈椎经椎弓根内固定的生物力学稳定性分析[J].中国组织工程研究与临床康复,2008,12(44):8725-8728.
[52]朱彦昭,徐荣明,吴建民.下颈椎椎弓根螺钉内固定的研究进展[J].中医正骨,2010,22(8):62-65.
[2]Alshami AM.Prevalence of spinal disorders and their relationships with age and gender.Saudi Med J.2015;36(6):725-730.
[3]黄宏,段伯良.颈椎生理曲度与颈椎病[J].右江医学,2002,30(4):319-319.
[4]范凌,潘显明,屈波,等.下颈椎退变不稳的诊断和外科治疗[J].重庆医科大学学报,2011,36(4):493-495.
[5]李宏达,夏群,白剑强,等.健康成人下颈椎在体三维瞬时运动特点研究[J].中国修复重建外科杂志,2015,29(12):1494-1499.
[6]Abumi K,Itoh H,Taneichi H,et al.Transpedicular screw fixation for traumatic lesions of the middle and lower cervical spine:description of the techniques and preliminary report.J Spinal Disord.1994;7(1):19-28.
[7]金宇恒,杨光,郝玉刚,等.颈椎椎弓根钉棒系统内固定在下颈椎骨折脱位治疗中的临床应用[J].中国医学前沿杂志:电子版,2015,7(11):69-73.
[8]Abumi K,Shono Y,Kotani Y,et al.Indirect posterior reduction and fusion of the traumatie herniated dise by using a cervical pedicle screw system.J Neurosurg.2000;92(1):30-37.
[9]傅一山,陈正形.颈椎弓根置钉的影像学测量[J].中国脊柱脊髓杂志,2001,11(1):29-31.
[10]Cao J,He F,He L,et al.Experimental study on screw insertion in lower cervical pedicle assisted by multi-spiral computerized tomography three dimensional reconstruction techniques.Zhongguo Xiufu Chongjian Waike Zazhi.2010;24(5):525-530.
[11]王东来,唐天驷,黄士中,等.下颈椎椎弓根内固定的解剖学研究与临床应用[J].中华骨科杂志,1998,18(11):659-662.
[12]Panjabi MM,Duranceau J,Goel V,et al.Cervical human vertebrae.Quantitative three-dimensional anatomy of the middle and lower regions.Spine.1991;16(8):861-869.
[13]谢宁,李家顺,贾连顺,等.颈椎后结构的影像学测量及其临床意义[J].中国脊柱脊髓杂志,1999,9(5):266-268.
[14]李治国.颈椎椎弓根形态个体化术前应用CT测量评价的临床意义[J].中国CT和MRI杂志,2016,14(6):130-132.
[15]苏培强,曾时兴,刘尚礼,等.术前CT测量对颈椎椎弓根形态个体化评价的意义[J].中国临床解剖学杂志,2007,25(5):515-517.
[16]贺永进,李长红,刘志斌.多层螺旋CT扫描三维重建技术测量下颈椎椎弓根相关参数的可行性研究[J].广西医科大学学报,2016,33(2):286-289.
[17]Nottmeier EW,Pirris SM.Placement of thoracic transvertebral pedicle screws using 3D image guidance.J Neurosurg Spine.2013;18(5):479-483.
[18]U?ur HC,Attar A,Uz A,et al.Surgical anatomic evaluation of the cervical pedicle and adjacent neural structures.Neurosurgery.2000;47(5):1162-1168.
[19]周树成,张鹏.下颈椎椎弓根相邻解剖结构的应用研究[J].局解手术学杂志,2016,25(1):30-32.
[20]袁欣华,庞清江,许柯,等.下颈椎椎弓根通道穿透力及突破力的生物力学研究[J].现代实用医学,2012,24(10):1096-1098+1201.
[21]胡宗,杨广忠.下颈椎椎弓根螺钉固定的相关研究进展[J].兵团医学,2011,27(1):37-40.
[22]Kotani Y,Cunningham BW,Abumi K,et al.Biomechanical analysis of cervical stabilization systems.An assessment of transpedicular screw fixation in the cervical spine.Spine.1994;19(22):2529-2539.
[23]王东来,唐天驷,黄士中.五种颈椎内固定方法的稳定性生物力学评价[J].中华外科杂志,1999,37(5):301-303.
[24]夏军,顾昕,黄煌渊.四种下颈椎内固定技术初始稳定性的生物力学比较[J].中华创伤骨科杂志,2004,6(4):430-433.
[25]Jones EL,Heller JG,Silcox DH,et al.Cervical pedicle screws versus lateral mass screws.Anatomic feasibility and biomechanical comparison.Spine.1997;22(9):977-982.
[26]Kowalski JM,Lucwig SC,Hutton WC,et al.Cervical spine pedicle screws:a biomechanical comparison of two insertion techniques.Spine.2000;25(22):2865-2867.
[27]刘淼,尚显文,宁旭,等.椎弓根螺钉及颈椎体螺钉置入内固定后的生物力学及稳定性比较[J].中国组织工程研究,2016,20(35):5210-5215.
[28]朱瑜琪.颈椎椎弓根螺钉置入固定失稳颈椎[J].中国组织工程研究,2012,16(39):7358-7365.
[29]王捷,郭志辉,潘子毅.下颈椎后路三种内固定稳定性的生物力学测试和评价[J].中国中医骨伤科杂志,2007,15(10):4-10.
[30]朱道平,刘克斌,黄奎.后路减压固定治疗伴椎间盘突出的下颈椎骨折脱位[J].骨科,2014,5(2):98-101.
[31]段扬.下颈椎后路内固定技术的有限元比较研究[D].南方医科大学,2011.
[32]孙程帅,李雷,孟伟宁.颈椎后路椎弓根螺钉内固定术治疗脊髓型颈椎病患者的疗效分析[J].沈阳医学院学报,2016,18(4):245-247.
[33]李书纲,盛林,赵宏,等.计算机导航技术在脊柱椎弓根钉固定中的应用[J].中华医学杂志,2009,89(11):736-739.
[34]Hwang TJ,Kiang C,Paul M.Surgical applications of3-dimensional printing and precision medicine.JAMA.2015;141(4):305-306.
[35]Giesel FL,Hart AR,Hahn HK,et al.3D reconstructions of the cerebral ventricles and volume quantification in children with brain malformations.Acad Radiol.2009;16(5):610-617.
[36]王远政,田晓滨,刘洋,等.Mimics及颈椎模型用于下颈椎椎弓根个体化置钉的应用研究[J].第三军医大学学报,2012,34(15):1543-1547.
[37]Guarino J,Tennyson S,Mc Cain G,et al.Rapid prototyping technology for surgeries of the pediatric spine and pelvis:benefits analysis.J Pediatr Orthop.2007;27(8):955-960.
[38]Gelalis ID,Paschos NK,Pakos EE,et al.Accuracy of pedicle screw placement:a systematic review of prospective in vivo studies comparing free hand,fluoroscopy guidance and navigation technique.Eur Spine J.2012;21(2):247-255.
[39]房岩,孙刚,丛茜,等.仿生材料学研究进展[J].农业机械学报,2006,37(11):163-167.
[40]王镓垠,柴磊,刘利彪,等.人体器官3D打印的最新进展[J].机械工程学报,2014,50(23):119-127.
[41]Langer R.Tissue engineering:perspectives,challenges,and future directions.Tissue Eng.2007;13(1):1-2.
[42]宋柯,付茂庆,孔祥雪,等.生物安全性的下颈椎后路经椎弓根固定的个性化导航模板研究[J].中国临床解剖学杂志,2012,30(5):509-512.
[43]张振辉,王庆德,梅伟,等.快速成型个体化导航模板辅助颈椎椎弓根螺钉的置入[J].中国组织工程研究,2017,21(3):340-344.
[44]宁金沛,吴卫东,覃求,等.3D打印个体化导航模板在胸椎和颈椎椎弓根螺钉植入的临床应用[J].实用骨科杂志,2015,21(5):385-389.
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