长节段固定融合术治疗成人脊柱侧凸下端椎选择的研究进展

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1、授予单位代码10089学号或申请号10010010055中国图书分类号R681.5HebeiMedicalUniversity硕士学位论文专业学位长节段固定融合术治疗成人脊柱侧凸下端椎选择的研究进展研究生：高显达导师：申勇教授专业：外科学二级学院：第三医院2018年3月目录中文摘要··········································································································1英文摘要··········································

2、································································2英文缩写··········································································································4综述长节段固定融合术治疗成人脊柱侧凸下端椎选择的研究进展········5致谢···············································································

3、···································22个人简历··········································································································23中文摘要长节段固定融合术治疗成人脊柱侧凸下端椎选择的研究进展摘要长节段固定融合术作为一种重要的手术方式，在临床应用中获得了良好的临床疗效，然而下端椎的选择一直是学者们不断争议的问题之一。下端椎的选择分为螺钉止于L5、S1或髂骨。争议的焦点主要是选择不同下端椎所产生的并发症发生率及严重性。下

4、端椎止于L5较S1有很多明显的益处，如减少手术时间和出血量、保留了腰骶部的活动度、较低的假关节发生率和内固定相关并发症，但是也同样会出现很多相应的并发症，如继发性椎间盘加速退变、继发性矢状面失平衡、腰椎前凸丢失，这几种并发生常常并非单独存在，而是互相影响，互为危险因素。下端椎融合至S1可以降低以上并发症，但是由于应力集中等原因，假关节的形成和内固定物相关并发症发生率增加，这两种并发症经常同时出现，相互促进。为了解决融合至S1带来的一系列并发症，学者们开始探索融合至髂骨或骨盆来解决这些问题，这类固定以髂骨钉和S2AI螺钉为代表，髂骨钉的并发症如螺钉尖端可能突破骨皮质，螺钉尾端附近的皮

5、肤破溃和螺钉相关腰骶部疼痛，这些并发症限制了髂骨钉的应用，S2AI螺钉的强度与髂骨钉类似，但其并发症发生率显著小于髂骨钉，但是S2AI螺钉应用时间尚短，远期临床疗效和并发症还有待进一步观察。关键词：成人脊柱侧弯，长节段固定融合术，下端椎，并发症，综述1英文摘要TheChoiceofCaudalExtentinLongFusionsArthrodesisStoppingatL5forAdultScoliosis:aSystematicReviewABSTRACTLongfusionsarthrodesissurgeryforadultscoliosishasshowngoodclin

6、icalresultsasanimportantsurgicalprocedure.However,thecontroversieswithreferencetothepotentialcaudalextentsofthefusionstillexist.Therewereseveralchoicesforcaudalextents:L5,S1,IliacscrewsorS2alar-iliac(S2AI)screws.Thefocusofthecontroversyisthecomplicationsandseverityofthemfromdifferentcaudalexte

7、nts.TherearesomeobviousadvantagesforcaudalextenttoL5versusS1:decreasingoperativetimeandbleeding,preservingthemotionoflumbosacralregion,lowerincidenceofpseudarthrosisandscrew-relatedcomplications.However,therearealsosomecomplicationsoccu