伤椎椎弓根置钉植骨治疗胸腰椎骨折的应用现状及进展

背景：经后路伤椎椎弓根置钉植骨的手术方式近年来被广泛运用于治疗胸腰椎骨折,既往对其可行性、有效性、安全性等方面都进行了大量的生物力学和临床研究,但仍然存在较多争议。目的：对经后路伤椎椎弓根置钉植骨治疗胸腰椎骨折的有效性和安全性研究现状及进展作一综述。方法：应用计算机检索维普和Pubmed数据库中1989年1月至2011年9月关于伤椎椎弓根置钉植骨治疗胸腰椎骨折的文章,在标题和摘要中以＂胸腰椎骨折,伤椎,固定,植骨＂或＂thoracolumbar fractures,injured vertebral,fixation,bonegraft＂为检索词进行检索。最终选择33篇文献进行综述。结果与结论：经后路伤椎椎弓根置钉植骨治疗胸腰椎骨折不仅为骨折愈合提供了更为坚稳的内固定,同时有助于骨折复位和后凸畸形的矫正,恢复和维持椎体高度,减少矫正率的丢失。但目前报道的手术疗效以回顾性分析居多,缺乏长期随访、系列的前瞻性分析和循证医学依据,并且对伤椎置钉的适应证、安全性和技术规范还存在较大争议,这些都有待进一步去研究和完善。

Transpedicular instrumentation of bone graft and vertebral pedicle screw in fractured vertebra for the treatment of thoracolumbar fractures

BACKGROUND：The posterior transpedicular instrumentation of bone graft and vertebral pedicle screw in fractured vertebra has been widely used in the treatment for thoracolumbar fractures.Prior to its feasibility,effectiveness,safety and other aspects of biomechanics and clinical research,but there are still more controversial.OBJECTIVE：To summarize the effectiveness and security of thoracolumbar fractures treated with posterior transpedicular instrumentation of bone graft and vertebral pedicle screw in fractured vertebra.METHODS：VIP database and PubMed database（1989-01/2011-09） were used to search the related articles about the treatment of thoracolumbar fractures with posterior transpedicular instrumentation of bone graft and vertebral pedicle screw in fractured vertebra.The key words of ＂thoracolumbar fractures,injured vertebral,fixation,bone graft＂ in Chinese and English were put in the title and abstract to search the relate articles.Finally,a total of 33 articles were included to review. RESULTS AND CONCLUSION：The posterior transpedicular instrumentation of bone graft and vertebral pedicle screw in fractured vertebra is a more solid fixation,while helping to fracture reduction and kyphosis correction,and benifit to restore and maintain the vertebral height,reduce the correction rate of loss.However,the surgery reports at present are mainly the retrospective analysis,and there lacks the long-term follow-up,a series of forward-looking analysis and research,as well as the evidence-based medicine,and there is considerable controversy on the indications of nail set on the injured vertebral,security and technical specifications,which need further study and improvement.