胸椎生长与胸椎椎弓根植入物及其相互关系

胸段脊柱的生长主要体现为形态学定量变化,是胸段脊柱体生长和胸廓正常生长的重要保证.对胸椎纵向生长的规律性进行研究,有助于了解脊柱病理性改变,特别是对于临床上胸段脊柱畸形治疗方案的确定,如胸椎椎弓根植入物的选择.胸椎椎弓根固定技术主要包括Roy-Camille技术、Steffee技术、Dick技术、RF技术、AF技术,相对于其他固定技术,一般认为AF系统内固定创伤小,具有强大的轴向撑开力,且结构简单,操作方便,尤其是对胸椎段脊柱畸形的矫正效果满意,在一定程度上避免了胸椎生长过程出现的曲轴现象.在胸椎椎弓根植入物的临床应用上,为了提高置入的准确性、安全性,研究者对植入物定位、植入方法及生物力学特点进行了大量研究,并开始应用CT扫描导航辅助胸椎椎弓根钉置入.但对于处于脊柱生长期的儿童来讲,如采用椎弓根植入系统对胸段脊柱侧弯进行矫正,可能使胸椎段丧失一部分生长能力或造成胸椎畸形.

Thoracic vertebrae growth, thoracic vertebral pedicle implants, and their correlation

The growth of cervicothoracic spine exhibits morphological quantitative changes,which is the support for the growth of whole spinal and thoracic cage.Research concerning regularity of longitudinal growth is conductive to understanding spinal pathological changes,especially for spinal deformity therapy.Techniques for thoracic vertebral pedicle fixation comprises Roy-Camilla,steffee,Dick,RF and Atlas Fixator (AF).Compared to other methods,AF is characterized by small trauma,strong axial bracing load,with satisfactory rectification results,which can avoid crankshaft phenomenon in a certain extent.In order to increase accuracy and safety of thoracic vertebral pedicle implantation,the implants positioning,imbedding method,as well as biomechanic characteristics were studied,and CT scanning was used as assistants.However,the thoracic vertebral pedicle implantation is unsatisfied to children,which may deprive partly of spinal growth capability or result in thoracic deformity.