摘要
关节突关节是脊柱生物力学结构的重要组成部分,关节突关节损伤会破坏脊柱运动节段的稳定性并加速邻近节段退变。因椎弓根螺钉置入而导致的关节突关节损伤是临床中常见却极易被忽视的原因,减少术中关节突关节的破坏对减少术后邻近节段退变具有重要意义。关节突关节损伤率与置钉技术相关。首先是机器人辅助置钉、计算机导航置钉和皮质骨通道置钉技术、其次是临床中广泛应用的开放椎弓根螺钉置入技术,都能够较好地保护关节突关节,而传统X线引导下的置钉技术容易造成关节突关节损伤。各种置钉技术造成关节突关节损伤的主要原因是置钉过程中参考的解剖标志不同、辅助置钉工具选择的差异以及椎旁软组织的干扰。此外,某些危险因素如关节突关节角、置钉节段、腰椎退变和学习曲线效应也会影响术中关节突关节的损伤率。本文比较了各种置钉技术对关节突关节造成损伤的差异,总结了不同置钉技术造成关节突关节损伤的原因及关节突关节损伤的危险因素,为减少关节突关节的破坏、优化置钉技术、进而降低邻近节段退变的发生提供参考依据。
Facet joint is the important part of spinal biomechanical structures.The damage of facet joint will destroy the stability of spinal motion segments and accelerate the adjacent segments degeneration(ASD).The violation of cranial facet joint based on various screw insertion techniques is a common but easily overlooked factor in clinical application.The reduction of intra-operative cranial facet joint violation is essential for reduction of postoperative ASD.The rates of facet violation are related to screw insertion techniques.The insertion techniques,including robot-assisted guidance,computer-assistant navigation,and cortical bone trajectory,are used successfully well in protecting cranial facet joints,compared with the freehand pedicle screw placement technique,which has been widely utilized in clinical practice.However,the conventional X-ray guided screw insertion technique is associated with a higher rate of facet violation.The main reasons why different techniques lead to various rates of facet violation include various anatomical referenced landmarks during screw insertion,selection of assisted equipment for instruments,and resistance of soft tissues of the spine.In addition,the related risk factors,such as facet angle,screw insertion segments,lumbar degeneration,and learning curve effect,can also affect the rates of facet violation.In the present study,we compared the differences of facet joint violation when using various screw techniques,and summarized the causes of violations and related risk factor.The present review might provide references for surgeons regarding the decrease of cranial facet joint violation,optimization of insertion techniques and reduction of ASD.
作者
周鲁平
章仁杰
张来
申才良
Zhou Luping;Zhang Renjie;Zhang Lai;Shen Cailiang(Department of Orthopaedics&Spine Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第18期1291-1298,共8页
Chinese Journal of Orthopaedics
基金
国家重点研发计划项目(2018YFC0114708)。
