Analysis and Management for Complications of Thoracolumbar Pedicle Screw Fixation_West China Medical Journal

Authors：

WANG Jin

Department of Spine and Traumatic Surgery, Dazhou Central Hospital, Dazhou, Sichuan 635000, P. R. China;

Corresponding?author：

Keywords：

胸腰椎; 椎弓根釘; 內固定; 并發癥

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【摘要】　目的　探討胸腰椎椎弓根釘內固定并發癥原因及預防措施。　方法　回顧性分析2006年12月-2010年12月行胸腰椎經椎弓根釘內固定治療失敗的21例患者臨床資料。手術均采用經椎弓根釘內固定。誤入椎管或穿出椎弓根外壁4例，螺釘斷裂4例，定位失誤3例；術后1~23個月內固定松動9例，其中術后1~2個月第1次X線片檢查發現松動3例，術后1~3個月內固定松動并感染2例；誤診1例（腰椎腫瘤、病理性骨折診斷為骨質疏松骨折）。19例再次手術。　結果　 21例均獲隨訪，隨訪時間3~34個月，平均18.5個月。12例重新固定、植骨融合患者內固定位置良好，未發現內固定松動、斷裂或脫出，植骨獲得骨性愈合。8例內固定物取出，5例無腰、背部疼痛，腰部活動正常，3例述偶感腰、背部不適，腰部活動尚好，1例感腰、背部疼痛，影響日常活動。1例死亡。　結論　椎弓根螺釘內固定并發癥多方面因素引起的，應充分認識，有效的骨折節段融合、術中仔細操作、預防感染、正確的康復鍛煉等，可有效減少胸腰椎椎弓根內固定失敗。
【Abstract】　Objective　 To discuss the reasons and preventive measures for complications of thoracolumbar pedicle screw fixation.　Methods　 Retrospective analysis of thoracolumbar pedicle screw fixation failure in 21 cases between December 2006 and December 2010 was carried out in this study. The pedicle screw fixation was used in all operations. Straying into the spinal canal or piercing the outer wall of the pedicle during operations happened in 4 cases, screw breakage in 4 cases, and positioning error in 3 cases. Internal fixation was loosened 1 to 23 months after operation in 9 cases, among which 3 were detected at the first X-ray examination 1 to 2 months after operation, 2 were found with infections 1 to 3 months after operation, and 1 was misdiagnosed (spinal tumor with pathological fracture misdiagnosed as osteoporotic fractures). Reoperation was performed for 19 cases.　Results　 All the patients were followed up for 3 to 34 months with an average time of 18.5 months. In the 12 patients who had undergone refixation, the location of the internal fixation was good without loosening, breakage or extrusion, and the grafts obtained bone healing. Internal fixation was removed in 8 patients, among whom 5 had no pain in the waist or back with normal waist activity, and 3 described waist and back discomfort occasionally with fair lumbar activity. One patient felt waist and back pain affecting daily activities. And one patient died.　Conclusions　 Pedicle screw fixation complications are caused by various factors. Fully understanding of the effective integration of the fracture segments, careful intraoperative management, infection prevention, and proper rehabilitation exercises can effectively reduce the thoracic and lumbar pedicle screw failure.

Citation： WANG Jin. Analysis and Management for Complications of Thoracolumbar Pedicle Screw Fixation. West China Medical Journal, 2011, 26(10): 1505-1507. doi: Copy

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6.	金才益, 曾忠友, 徐阿炳, 等. 胸腰椎骨折單純椎弓根螺釘系統治療的遠期結果[J]. 中國脊柱脊髓雜志, 2002, 12(5): 398-399.
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8.	王大正, 唐開. 胸腰斷骨折椎弓根內固定系統失效原因分析[J]. 中國醫師進修雜志, 2006, 29(17): 67-77.
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10.	畢琳莉. 腰椎內固定術后遲發性感染的原因分析[J]. 中華現代外科雜志, 2009, 6(5): 282-283.
11.	張英澤, 李寶俊, 張奇, 等. 胸腰椎骨折椎弓根內固定術后失敗原因探討[J]. 中華骨科雜志, 2009, 29(1): 7-11.
12.	李劍勇. 椎弓根釘內固定治療胸腰椎骨折并發癥分析[J]. 實用骨科雜志, 2007, 13(10): 213-214.
13.	徐永清, 陸聲. 骨質疏松性骨折的預防和治療[J]. 創傷外科雜志, 2006, 7(6): 574-576.

1. 　劉良樂, 湯呈完, 楊國敬. 胸椎椎弓根螺釘置入技術的研究現狀與展望[J]. 中國脊柱脊髓雜志, 2011, 21(2): 148-150.
2. 　Esses SI, Sachs BL, Dreyzin V. Complications associated with the technique of pedicle screw fixation.A selected survey of ABS members[J]. Spine(Phila Pa 1976), 1993, 18(15): 2231-2239.
3. 　Roy-Camille R, Saillant G, Mazel C. Internal fixation of the lumbar spine with pedicle screw plating[J]. Clin Orthop Relat Res, 1986(203): 7-17.
4. 　孫建峰, 唐子華. 胸腰椎骨折經椎弓根內固定失誤及預防[J]. 中華矯形外科雜志, 2009, 17(14): 278-280.
5. 　Antevil JL, Sise MJ, Sack DI, et al. Spiral computed tomography for the initial evaluation of spine trauma: a new standard of care[J]. J Trauma, 2006, 61(2): 382-387.
6. 　金才益, 曾忠友, 徐阿炳, 等. 胸腰椎骨折單純椎弓根螺釘系統治療的遠期結果[J]. 中國脊柱脊髓雜志, 2002, 12(5): 398-399.
7. 　張貴林, 榮國威, 丁占云, 等. 脊柱胸腰段骨折術后椎弓根螺釘斷裂及彎曲松動的原因分析[J]. 中華骨科雜志, 2000, 20(8): 470-473.
8. 　王大正, 唐開. 胸腰斷骨折椎弓根內固定系統失效原因分析[J]. 中國醫師進修雜志, 2006, 29(17): 67-77.
9. 　Delawi D, Dhert WJ, Castelein RM, et al. The incidence of donor site pain after bone graft harvesting from the posterior iliac crest may be overestimated: a study on spine fracture patients[J]. Spine(Phila Pa 1976), 2007, 32(17): 1865-1868.
10. 　畢琳莉. 腰椎內固定術后遲發性感染的原因分析[J]. 中華現代外科雜志, 2009, 6(5): 282-283.
11. 　張英澤, 李寶俊, 張奇, 等. 胸腰椎骨折椎弓根內固定術后失敗原因探討[J]. 中華骨科雜志, 2009, 29(1): 7-11.
12. 　李劍勇. 椎弓根釘內固定治療胸腰椎骨折并發癥分析[J]. 實用骨科雜志, 2007, 13(10): 213-214.
13. 　徐永清, 陸聲. 骨質疏松性骨折的預防和治療[J]. 創傷外科雜志, 2006, 7(6): 574-576.

West China Medical Journal

Analysis and Management for Complications of Thoracolumbar Pedicle Screw Fixation

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