中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (26): 4872-4875.doi: 10.3969/j.issn.1673-8225.2011.26.031

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

增加椎弓根螺钉稳定性的方法与技术研究进展

周子红1，程  立1，殷渠东2   

  1. 1无锡市人民医院骨科，江苏省无锡市  214000
    2无锡骨科医院，江苏省无锡市214000
  • 收稿日期:2011-02-22 修回日期:2011-03-16 出版日期:2011-06-25 发布日期:2011-06-25
  • 作者简介:周子红★，男，1970年生，江苏省无锡市人，汉族，1990年徐州医学院毕业，硕士，主治医师，主要从事脊柱外科基础和临床研究。 yinqudong@sina.com

Research progress in stability of pedicle screw

Zhou Zi-hong1, Cheng Li1, Yin Qu-dong2   

  1. 1Department of Orthopedics, Wuxi People’s Hospital, Wuxi  214000, Jiangsu Province, China
    2Department of Orthopedics, Wuxi Orthopedic Hospital, Wuxi  214000, Jiangsu Province, China
  • Received:2011-02-22 Revised:2011-03-16 Online:2011-06-25 Published:2011-06-25
  • About author:Zhou Zi-hong★, Master, Attending physician, Department of Orthopedics, Wuxi People’s Hospital, Wuxi 214000, Jiangsu Province, China yinqudong@sina.com

PDF

413

被引次数

10

摘要：

背景：椎弓根螺钉贯穿脊柱前中后三柱，具有三维矫正作用，已成为标准的脊椎后路内固定方法。但骨质疏松患者容易出现螺钉松动和复位矫正丢失、螺钉翻修或者重新调整螺钉位置后螺钉的稳定性较差。
目的：总结分析涉及螺钉稳定性有关研究，介绍增加 椎弓根螺钉稳定性方法与研究进展。
方法：以 “Bone nails，Osteoporosis, Revision，Pedicle screw，Stability，骨钉，骨质疏松，翻修，椎弓根螺钉，稳定性”为关键词检索1990/2010 PubMed数据库、中国知网数据库、维普数据库。
结果与结论：增加椎弓根螺钉稳定性的重点是提高螺钉抗拔力。骨水泥加强或更换较粗、较长螺钉或使用特殊螺钉可以使螺钉稳定性绝对值增加。上下和左右螺钉不同连接方式、螺钉不同方向置入也将影响整套器械中螺钉的稳定性，这是螺钉稳定性相对值变化。每种方法都有优缺点，临床应用应根据具体情况选择不同方法。一般来讲，对于Jikei分级Ⅱ级以下的骨质梳松脊椎采用较粗和较长螺钉，同时结合采用螺钉与连接棒强直性连接、加横向连接装置、左右、上下螺钉以较大成角置入螺钉等方法提高螺钉稳定性较安全、方便；对于Jikei分级Ⅱ级以上的骨质梳松，必须采用更强的骨水泥加强技术或特殊螺钉方法来提高螺钉稳定性。

关键词: 骨钉, 骨质疏松, 翻修, 椎弓根螺钉, 稳定性

Abstract:

BACKGROUND: Pedicle screw which passes through the three columns and has three-dimensional correction function, which has quickly become the standard posterior spinal internal fixation. But loss of correction and screw loosening often occurs in patients with osteoporosis, or screw has less stability in revision surgery and re-adjust of screw position.
OBJECTIVE: To summarize and analyze the stability of pedicle screw, to introduce the methods of improving the stability of pedicle screw and its clinical applications.
METHODS: A computer-based online search of PubMed database, CNKI database, VIP database was performed for related articles published between 1990 and 2010 with key words “bone nails, osteoporosis, revision, pedicle screw, stability” in English and Chinese.
RESULTS AND CONCLUSION: The focus on increasing stability of pedicle screw is to increase screw withdrawal resistance. Screw augmented with bone cement or replaced with thicker, longer screws or special screws (hollow screw and expandable screw hole) can lead to increase in the absolute value of screw stability. Screws in the upper and the lower, the left and the right side with different connectors, different directions of placement will affect the stability of the entire device of pedicle screw, which is the change in the relative value of screw stability. Other methods are those such as improving structure of fixator, and adding with bone in screw-path, etc. Various methods have advantages and disadvantages, clinical application should be based on different situations to choose specific methods. In general for Osteoporosis below grade Ⅱ (Jikei grade), using thicker and longer screws, horizontal connection device and screws with stiff connection with rod. At the same time, screws in left and right, upper and down side placed with larger angle to increase the stability of pedicle screw is a safe and convenient way; for Osteoporosis grade Ⅱ or more , more reliable screw augmented method with bone cement or special screws to increase the stability of pedicle screw must be used.

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