摘要
腰椎融合术后邻近节段病(ASDis)是腰椎后路融合术后的常见并发症,常需行手术治疗。经皮脊柱内镜技术可在不拆除原先内固定的同时行单纯减压及镜下后路固定融合,或与其他入路固定融合技术相结合,具有手术创伤小、出血少及术后恢复快等优点。传统椎弓根螺钉技术因术中容易对邻近关节突关节造成损伤,是导致邻近节段退变发生的危险因素之一。而应用经皮质骨轨迹(CBT)置钉技术治疗ASDis,不仅能减少置钉过程中对关节突关节的损害,还能保留原内固定物,减少手术创伤。在三维打印导板、CT导航和机器人等数字化技术辅助下植入CBT螺钉,可更精准地完成邻近节段的“双钉”固定融合,对符合临床融合指征的ASDis患者是一种可考虑的微创手术方式。
Adjacent segment disease(ASDis)is a common complication of posterior lumbar spine fusion and often requires surgical treatment.In the treatment of ASDis,percutaneous spinal endoscopy can be used for simple decompression without removal of the original internal fixation,or for posterior fixation and fusion under the scope or in combination with other access fixation and fusion techniques,with the advantages of less surgical trauma,less bleeding,and faster postoperative recovery.Traditional trajectory screw technique is one of the risk factors for adjacent segment degeneration because of its tendency to cause damage to the adjacent synovial joint during surgery.In contrast,the cortical tone trajectory(CBT)screw placement technique not only reduces the damage to the articular joint during the screw placement process,but also preserves the original internal fixation in the treatment of ASDis,which significantly reduces the surgical trauma.Secondly,the implantation of CBT screws with the aid of digital technologies such as three-dimentinal printed guides,CT navigation,and robotics allows for more precise“double nailing”of ASDis patients to complete the fusion of adjacent segments,and is a minimally invasive procedure to be considered for patients who meet the clinical indications for fusion.This article reviews the literature on the use of percutaneous spinal endoscopy and CBT in the surgical management of ASDis.
作者
刘东山
王轶希
帕尔哈提·热西提
Liu Dongshan;Wang Yixi;Rexiti Paerhati(Department of Spinal Surgery,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Xinjiang Medical University,Urumqi 830054,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2023年第8期722-727,共6页
Chinese Journal of Surgery
基金
中国医学科学院中央级公益性科研院所项目(2022-JKCS-19)。
关键词
腰椎
脊柱融合术
邻近节段疾病
经皮内镜技术
皮质骨轨迹螺钉技术
数字化导航技术
Lumbar vertebrae
Spinal fusion
Adjacent segment disease
Percutaneous spinal endoscopy
Cortical bone trajectory screws
Digital navigation technology
