胸腰椎骨折并脊髓损伤的二次手术原因分析

目的　 总结分析各种原因手术失败而二次手术的胸腰椎骨折合并脊髓损伤的病例 ,以减少失误 ,提高疗效。 方法　初次手术单纯椎板减压 10例 ,Luque手术 8例 ,棘突钢板固定 4例 ,斯氏针钢丝固定 4例 ,AF手术 4例 ,RF手术 2例。同时行椎板减压 30例 ,3例行后路融合。针对不同失败原因采用不同二次手术方式。 结果　32例患者初次手术未行植骨融合。二次手术 2 0例获得平均 2年 6个月随访。 10例二次手术后神经功能有一定程度恢复。 6例轻度腰背疼 ,5例中度腰背疼。 5例后凸Cobb角大于 2 0°。 结论　正确选用内固定器械及手术方式 ,熟练掌握手术技巧 ,是确保手术成功的关键

Analysis of Reasons of Re- operation on Spinal Cord Injuries Complicated with Fractures of Thoracolumbar Vertebra

Objective To analyze the causes of re-operation on the spinal cord injuries complicated with fractures of thoracolumbar vertebra and to reduce the failure and improve the treatment effects.Methods For the first operation,10,cases received simple decompression;8 cases Luque operation;4 cases steel plate fixation of spinal process;4 cases steel wire fixation;4 cases AF fixation;2 cases RF operation and 30 patients received laminectomy and decompression simultaneously.3 cases received operation of posterior road fusion.Re-operation programs were introduced according to the causes of failure.Results 32 patients did'nt receive bone grafting fusion for their first operation.20 patients who received re-operation got follow up to 2 years and 6 months averagely.10 patients experienced improvement of nerve function after re-operation;6 mild backache;5 moderate backache;5 backward protrusion deformation that Cobb angle was more than 20 degree.Conclusion The corrrect use of internal fixation device and operation programs and skilled operation technique were the key guarantees of success operation.