经皮椎弓根螺钉治疗胸腰椎骨折的研究进展.docxVIP

经皮椎弓根螺钉治疗胸腰椎骨折的研究 进展 宗路杰袁振 苏州大学苏州市立医院骨科 摘要： 近年來胸腰椎骨折已经成为脊柱外科的常见病z—。椎弓根螺钉内固定是治疗胸 腰椎骨折的有效手段，但目前常用的传统后正中入路存在损伤大、并发症高的突 出问题。2001年,Sextant系统的发明是经皮椎弓根螺钉内固定(PPSF)的里程 碑，与传统开放手术相比，具有损伤小、出血少、感染风险低、术后疼痛轻、手 术吋间和住院吋间短等优点，但同时也存在放射剂量大、无法直接椎管减压和融 合等缺点。未来，随着各种新技术的发展会逐渐克服以上问题，并促使PPSF技 术不断扩大适应证，成为治疗胸腰椎骨折的主要置钉方式，造福更多患者。 关键词： 胸腰椎骨折;微创;经皮椎弓根螺钉; 作者简介：袁振，E-mail:yzl984312@163. com 收稿日期：2017-06-11 Research Progress of the Percutaneous Pedicle Screw Fixation in the Treatment of Thoracolumbar Fractures ZONG Lujie YUAN Zhen Soochow University; Department of Orthopedics, Suzhou Municipal Hospital: Abstract： In recent years, thoracolumbar fractures have become one of the common diseases of spinal surgery. Pedicle screw fixation is an effective treatment of thoracolumbar fractures, but the existenee of large damage and high complications is becoming more and more problematic for the common posterior open pedicle screw fixation. In 2001, the invention of the Sextant system was a miles tone in percu taneous pedicle-screw fixation (PPSF) , which leads to preservation of posterior musculature, lower infection risk, less postoperative pain, less blood loss, shorter operative time, as well as shorter hospital stay. Limitations of percutaneous fixation include large radiation dosage, inability to achieve direct spinal canal decompression and not having the option to perform a fusion. In the future, development of new technologies can expand the scope of indications and treatment possibi 1 ities using PPSF in spine trauma, bcncfiting more paticnts. Keyword： Thoracolumbar fracture; Minimally invasive; Percutaneous pedicle-screw fixation; Received： 2017-06-11 脊柱骨折占成人骨折的5%~6%,在我国主要由交通事故(33.61%)和高空坠落 (31.25%)引起;而因活动度较小的胸椎与活动度较大的腰椎直接相连，故腰椎 和胸椎骨折最常见，分别占脊柱骨折的56. 09%和23. 77%山。椎体骨折往往会破 坏脊柱稳定性结构而使脊柱变得不稳定，此时常需进行手术来恢复脊柱稳定性。 椎弓根螺钉内固定技术现已广泛应用于临床，主要分为微创经皮和开放手术两 种，均取得了较好的临床疗效。然而，传统后正屮入路的手术过程屮需要广泛剥 离椎旁软组织，并导致大量失血、椎旁肌去神经支配或萎缩，这些医源性创伤导 致的术后并发症已经引起学界的广泛关注。同时，经皮椎弓根螺钉内固定 (percutaneous pediclescrew fixation, PPSF)技术凭借确切的疗效，并具有