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; 椎弓根钉; 内固定; 并发症

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【摘要】　目的　探讨胸腰椎椎弓根钉内固定并发症原因及预防措施。　方法　回顾性分析2006年12月-2010年12月行胸腰椎经椎弓根钉内固定治疗失败的21例患者临床资料。手术均采用经椎弓根钉内固定。误入椎管或穿出椎弓根外壁4例，螺钉断裂4例，定位失误3例；术后1~23个月内固定松动9例，其中术后1~2个月第1次X线片检查发现松动3例，术后1~3个月内固定松动并感染2例；误诊1例（腰椎肿瘤、病理性骨折诊断为骨质疏松骨折）。19例再次手术。　结果　 21例均获随访，随访时间3~34个月，平均18.5个月。12例重新固定、植骨融合患者内固定位置良好，未发现内固定松动、断裂或脱出，植骨获得骨性愈合。8例内固定物取出，5例无腰、背部疼痛，腰部活动正常，3例述偶感腰、背部不适，腰部活动尚好，1例感腰、背部疼痛，影响日常活动。1例死亡。　结论　椎弓根螺钉内固定并发症多方面因素引起的，应充分认识，有效的骨折节段融合、术中仔细操作、预防感染、正确的康复锻炼等，可有效减少胸腰椎椎弓根内固定失败。
【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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11.	张英泽, 李宝俊, 张奇, 等. 胸腰椎骨折椎弓根内固定术后失败原因探讨[J]. 中华骨科杂志, 2009, 29(1): 7-11.
12.	李剑勇. 椎弓根钉内固定治疗胸腰椎骨折并发症分析[J]. 实用骨科杂志, 2007, 13(10): 213-214.
13.	徐永清, 陆声. 骨质疏松性骨折的预防和治疗[J]. 创伤外科杂志, 2006, 7(6): 574-576.

1. 　刘良乐, 汤呈完, 杨国敬. 胸椎椎弓根螺钉置入技术的研究现状与展望[J]. 中国脊柱脊髓杂志, 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. 　孙建峰, 唐子华. 胸腰椎骨折经椎弓根内固定失误及预防[J]. 中华矫形外科杂志, 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. 胸腰椎骨折单纯椎弓根螺钉系统治疗的远期结果[J]. 中国脊柱脊髓杂志, 2002, 12(5): 398-399.
7. 　张贵林, 荣国威, 丁占云, 等. 脊柱胸腰段骨折术后椎弓根螺钉断裂及弯曲松动的原因分析[J]. 中华骨科杂志, 2000, 20(8): 470-473.
8. 　王大正, 唐开. 胸腰断骨折椎弓根内固定系统失效原因分析[J]. 中国医师进修杂志, 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. 　毕琳莉. 腰椎内固定术后迟发性感染的原因分析[J]. 中华现代外科杂志, 2009, 6(5): 282-283.
11. 　张英泽, 李宝俊, 张奇, 等. 胸腰椎骨折椎弓根内固定术后失败原因探讨[J]. 中华骨科杂志, 2009, 29(1): 7-11.
12. 　李剑勇. 椎弓根钉内固定治疗胸腰椎骨折并发症分析[J]. 实用骨科杂志, 2007, 13(10): 213-214.
13. 　徐永清, 陆声. 骨质疏松性骨折的预防和治疗[J]. 创伤外科杂志, 2006, 7(6): 574-576.

West China Medical Journal

Analysis and Management for Complications of Thoracolumbar Pedicle Screw Fixation

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