下颈椎经椎弓根内固定的生物力学稳定性分析*★

经椎弓根固定是目前能提供三柱生物力学稳定性最可靠的脊柱后路内固定，具有很高的临床应用价值，但颈椎椎弓根毗邻结构复杂，螺钉置入风险很高，限制了其在临床的广泛应用。文章从颈椎椎弓根的形态，生物力学性能，椎弓根螺钉内固定技术和固定系统，手术导航，手术的适应证、禁忌证及并发症等不同研究侧面，总结国内外学者在以上相关领域，有关椎弓根固定在下颈椎疾病治疗方面的应用和进展，认为椎弓根固定虽然有很高风险，但通过术前精确测量椎弓根形态、术中结合各种新辅助技术、配合手感，下颈椎经椎弓根内固定的风险将降低，其在临床应用将越来越广泛。

Biomechanical stability of transpedicular screw fixation in lower cervical spine

Transpedicular screw fixation for cervical spine is the strongest spinal posterior fixation that could provide tri-column biomechanical stability, and it has been gradually identified as a quite high value in clinical application. The pedicle of vertebral arch is adjacent to vital neurovascular structures; thereby pedicle screw fixation in the cervical spine has been considered as a potential risk of injury and been limited in clinics. This study aims to review the studies on the current situation and progress of pedicle screw fixation techniques in lower cervical disease by investigating cervical pedicle morphology, biomechanical property, transpedicular screw insertion techniques and internal fixation system, computer assisted image-guided navigation, the indication, contraindication and complications of pedicle screw fixation. The article shows that preoperative careful evaluation for the morphology of the lower cervical pedicles, using kinds of new image guided techniques and meticulous techniques of screw placement in operation are essential in reducing operational risk and offering widely application.