摘要
目的:探讨后路椎弓根螺钉短节段内固定治疗胸腰椎骨折失败的原因及翻修策略。方法:2008年3月至2010年12月,对采用后路椎弓根螺钉短节段内固定手术失败的18例胸腰椎骨折患者进行回顾性分析,其中男11例,女7例;年龄19～63岁,平均37.2岁;初次手术至并发症出现时间为6～44个月,平均14.3个月。骨折不愈合7例(其中合并断钉4例),进行性神经功能障碍5例,进行性腰背痛6例。18例患者均出现不同程度后凸畸形。18例患者均行前路翻修手术治疗,其中保留后路内固定行前路手术9例,完全拆除内固定后前路手术9例。结果:所有患者获得随访,时间18～50个月,平均30.5个月。随访过程中,无内固定松动、断裂发生,X线及薄层CT扫描显示骨折愈合良好。ODI评分术前31.6±5.1,术后3个月8.6±5.7,末次随访8.3±3.2;VAS评分术前7.2±2.3,术后3个月2.3±0.7,末次随访2.1±1.1;后凸畸形术前(-21.2±7.8)°,术后3个月(-5.3±6.8)°,末次随访(-5.8±7.8)°。与术前比较,ODI、VAS评分和后凸畸形均明显改善(P<0.05)。结论:后路椎弓根螺钉短节段内固定治疗胸腰椎骨折可能出现内固定断裂、骨折不愈合、进行性后凸畸形等并发症;前路重建可能是治疗后路手术失败的一种有效方法。
Objective： To analyze the reason and strategy for failure of posterior pedicle screw short-segment internal fixa- tion on thoracolumbar fractures. Methods：From March 2008 to December 2010,the clinical data of 18 patients with thora- columbar fracture failed in posterior pedicle screw short-segment internal fixation were retrospectively analyzed. There were 11 males and 7 females with an average age of 37.2 years （ranged, 19 to 63）. The time from the first operation to complication oc- currence was from 6 to 44 months with an average of 14.3 months. Of them ,fusion failure was in 7 cases （combined with screw breakage in 4 cases）, the progressive neuro-dysfunction was in 5 cases, the progressive lumbodorsal pain was in 6 cases. All 18 patients with kyphosis were treated with anterior internal fixation remaining posterior fixation （9 cases） and anterior internal fixation after posterior fixation removal （9 cases）. Results： All the patients were followed up from 18 to 50 months with an av- erage of 30.5 months. No internal fixation loosening and breakage were found, moreover,X-ray and lamellar CT showed bone healing well. Preoperative, postoperative at 3 months and at final follow-up, ODI score was respectively 31.6±5.1,8.6±5.7,8.3±3.2 ;VAS score was respectively 7.2±2.3,2.3±0.7,2.1 ± 1.1 ; kyphosis angle was respectively （-21.2±7.8 ）°, （-5.3 ±6.8 ） °, （- 5.8±7.8 ）°. Compared with preoperative data, above-listed items had obviously ameliorated （P〈0.05）. Conclusion：Treatment of thoracolumbar fracture with posterior pedicle screw short-segment internal fixation may result in the complications such as bone nonunion, internal fixation breakage and progressive kyphosis. Anterior reconstruction may be a good strategy for the failure of posterior operation.
出处
《中国骨伤》
CAS
2013年第3期186-189,共4页
China Journal of Orthopaedics and Traumatology
关键词
脊柱骨折
骨折固定术
内
手术后并发症
Spinal fractures
Fracture fixation, internal
Postoperative complications
