Индивидуальные имплантаты в хирургии позвоночника: систематический обзор литературы

Цель исследования. Обобщение отраженного в литературе опыта применения индивидуальных имплантатов в хирургии позвоночника с анализом поставленных перед оперативным вмешательством задач и вариантов технического решения, а также нозологии, возраста пациентов, распределения случаев и публикаций по странам.

Материал и методы. Выполнен систематический поиск публикаций в электронных базах данных PubMed/Medline, GoogleScholar, eLibrary, а также в библиографических списках отобранных для анализа статей. В обзор включены публикации на английском и русском языках, описывающие клиническое применение индивидуальных имплантатов при хирургическом лечении заболеваний позвоночника.

Результаты. В итоговый анализ включили 41 источник, обработали данные о 340 случаях. В публикациях предложены технические решения для выполнения реконструкции С₁–С₂, стабилизации С₁–С₂, дистракции на вогнутой стороне деформации в субаксиальном шейном отделе, передней реконструкции позвонков субаксиального шейного, грудного и поясничного отделов, коррекции сагиттального либо фронтального баланса, достижения «нулевого» профиля имплантата, передней и задней стабилизации в неблагоприятных анатомических условиях. Использовались имплантаты следующих типов: передние верхнешейные с посадочными площадками для С₀ или С₁, имплантаты-шаблоны для трансартикулярного артродеза С₁–С₂, односторонние дистракционные спейсеры, конгруэнтные межтеловые имплантаты, конгруэнтные телозамещающие имплантаты, индивидуальные передние пластины, мостовидные передние имплантаты, «монолитные» имплантаты, воспроизводящие элементы стандартных изделий без соединительных узлов.

Заключение. Индивидуальные имплантаты использовались при несоответствии имеющихся серийных изделий поставленным задачам либо анатомическим особенностям пациента. Нозология в большинстве случаев представлена дегенеративными и онкологическими заболеваниями у лиц старшей возрастной группы.

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