腰椎椎弓根螺钉内固定技术研究进展

Research Progress in Lumbar Pedicle Screw Internal Fixation Techniques

摘要: 腰椎退行性疾病常始于椎间盘的退变，纤维环破裂损伤后椎间盘突出会导致椎间盘高度降低、关节突关节增生、椎管狭窄，继而引发神经根及硬膜囊受压出现腰腿痛，严重影响患者生活质量甚至致残。腰椎的退行性病变包括腰椎间盘突出症、腰椎椎管狭窄症、腰椎不稳、腰椎滑脱症以及退变性脊柱侧弯。有研究报道腰椎退行性疾病总患病率高达27.3%，其中女性高于男性(女性34.7%，男性18.1%)，且近年来随着人口老龄化程度的加剧，腰椎退行性疾病患病率也逐渐上升，75岁以上高年龄患者占比超50%。在治疗腰椎退变性疾病的众多术式中，椎弓根螺钉内固定系统具有即刻重建脊柱稳定性、实现三柱固定、矫形力量强大、减少假关节发生率及提高融合率等优势，在腰椎融合技术中起着不可或缺的作用。本文以腰椎椎弓根螺钉内固定技术的发展及相关固定技术的优势及不足作一篇综述。

Abstract: Degenerative lumbar diseases often originate from intervertebral disc degeneration. After annular fibrosus rupture and injury, disc herniation leads to reduced disc height, zygapophyseal joint hyperplasia, and spinal canal stenosis, which subsequently causes compression of nerve roots and the dural sac, resulting in low back and leg pain. This significantly impacts patients’ quality of life and may even lead to disability. Degenerative lumbar pathologies include lumbar disc herniation, lumbar spinal stenosis, lumbar instability, lumbar spondylolisthesis, and degenerative scoliosis. Studies have reported that the overall prevalence of degenerative lumbar diseases is as high as 27.3%, with a higher incidence in women than in men (34.7% in women, 18.1% in men). In recent years, with the intensification of population aging, the prevalence of degenerative lumbar diseases has gradually increased, with patients over 75 years old accounting for more than 50% of cases. Among the various surgical techniques for treating degenerative lumbar diseases, the pedicle screw internal fixation system offers advantages such as immediate reconstruction of spinal stability, three-column fixation, powerful corrective force, reduced pseudarthrosis rates, and improved fusion rates. It plays an indispensable role in lumbar fusion techniques. This article provides a review by examining the development of lumbar pedicle screw internal fixation technology and discussing the advantages and limitations of related fixation techniques.