哪种脊柱固定技术在胸脊柱创伤后实现了什么程度的稳定性? 一个系统的定量审查
Ann-Kathrin Greiner-Perth1, Hans-Joachim Wilke1, Christian Liebsch1
1Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University, Ulm, Germany.
概括
创伤性脊柱损伤的手术固定对于稳定性至关重要. 像环形固定等更具侵入性的技术为严重的伤害提供了更大的稳定性,而更少的侵入性方法适合轻微的伤害. 纯粹的增强对于复杂的脊柱不稳定性是不够的.
科学领域:
- 脊柱外科手术 脊柱外科手术
- 生物力学 生物力学
- 创伤学 创伤学 创伤学
背景情况:
- 不稳定的创伤性脊柱损伤需要手术固定以恢复生物力学稳定性.
- 对于胸脊柱脊柱损伤,存在各种手术固定策略.
研究的目的:
- 总结和量化创伤性胸脊柱脊柱损伤的手术固定后的三维脊柱稳定性.
- 基于实验研究,比较不同治疗策略的疗效.
主要方法:
- 在体外研究的系统文献综述.
- 在PubMed和Web of Science中基于关键字的搜索.
- 提取和评估生物力学稳定性参数 (运动范围,中立区域,转移) 和实验设计.
主要成果:
- 包括66项研究,重点关注爆裂骨折 (AOSpine A4) 和不完整的伤害 (AOSpine A3).
- 较少的侵入性方法 (增强性,后部) 适合轻微伤害;双细分后部固定稳定了轻微的压缩伤害.
- 严重的伤害 (AOSpine A4,C) 往往保持不稳定与更少的侵入性固定;周围或脊椎体置换提供了全面的稳定.
- 纯增强技术不能恢复多方向稳定性.
- 胸部损伤在曲/延伸方面表现不稳定;胸椎/腰椎损伤在轴旋转方面表现不稳定.
结论:
- 手术治疗的有效性取决于损伤类型,严重程度,位置和固定策略.
- 纯增强技术无法恢复复杂的多维稳定性.
- 周围仪器或脊椎体置换为严重的脊柱损伤提供了卓越的稳定性.
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