胸腰椎AF、RF椎弓根钉系统的手术后并发症

目的：了解ＡＦ、ＲＦ椎弓根钉系统常见并发症,分析手术失误原因。方法：回顾分析１９９５年以来,应用ＡＦ、ＲＦ椎弓根系统治疗各类胸腰椎疾患６０例,对手术疗效,手术后并发症,手术失误原因进行了随访总结。结果：６０中例超过半年以上的完整病史５５例。胸腰椎骨折行ＡＦ钉复位内固定４５例,腰椎滑脱症行ＲＦ钉复位内固定１０例。平均随访时间３２个月,优良率８２％。 主要并发症是：钉位差、内固定物松动折断、伤口感染等     

SF内固定器治疗胸腰椎骨折及腰椎滑脱症

总结ＳＦ内固定器治疗胸腰椎骨折及腰椎滑脱症疗效。方法：在开展Ｄｉｃｋ、Ｓｔｅｆｆｅｅ、ＲＦ手术的基础上,采用ＳＦ内固定器治疗胸腰椎骨折及腰椎滑脱症。随访１２－２６个月。结果：腰椎骨折１５例,１０例完全恢复椎体高度,５例椎体高度不同程度恢复,后凸Ｃｏｂｂ角平均矫正率为８７．８％。     

腰椎滑脱症和胸腰椎骨折的内固定器研制及其临床应用

目的：为了提高脊柱内固定器的复位效果。方法：通过对腰椎滑脱症发病机理的探讨和３１８例胸腰椎骨折治疗的分析，作者设计了一种用于治疗腰椎滑脱症和胸腰椎骨折的新型内固定器（ＳＦ内固定器）。结果：经４２例胸腰椎骨折和１７例腰椎滑脱症临床应用，其中４１例获６个月以上随访（６～３８个月，平均１３．４个月），效果满意，操作简便，值得推广。     

DRFS在胸腰椎手术中的应用

目的：评价撑开、复位、内固定系统(Distraction Reduce Fixation System DRFS)在胸腰椎手术中的应用价值。方法：对胸腰椎骨折26例，结核10例，腰椎滑脱24例病人均行DRFS内固定及植骨融合术。结果：随访4～36个月，平均14个月，26例胸腰椎骨折生理曲度恢复，伤椎高度恢复90％，神经功能除1例A级的无改善外，其余的均有1～2个级别的提高；结核10例，后突畸形矫正．脊柱稳定，植骨在4～5个月内融合，无1例复发；滑脱24例，20例完全复位占83．3％。无1例出现断钉、折板、螺钉松动。结论：DRFS材料优质、设计合理、操作简单，在术中同时完成撑开、复位、固定作用，效果优良，是胸腰椎手术中理想的内固定物。     

经伤椎单节段椎弓根钉固定结合球囊扩张自体植骨治疗胸腰椎骨折

目的 探讨经伤椎单节段椎弓根钉固定结合球囊扩张自体植骨治疗胸腰椎骨折的方法及临床疗效.方法 采用体位复位、球囊扩张及椎体内植骨并经伤椎行脊柱内固定治疗胸腰椎骨折17例.结果 随访4～36个月,平均19.2个月,术后Cobb角、椎体高度均恢复满意,骨折均愈合,内固定无松动及断裂.内固定取出后未发现椎体高度丢失及后凸畸形.无手术并发症.结论 经伤椎单节段椎弓根钉固定结合球囊扩张自体植骨治疗胸腰椎骨折,操作安全,疗效满意.     

胸腰椎椎弓根内固定系统并发症的处理和预防

目的：分析胸腰椎椎弓根内固定系统并发症的原因，提出预防措施和处理方法。方法：对1994年11月－2001年4月处理的103例胸腰椎骨折和椎弓断裂滑脱患者进行总结，并对19例并发症原因加以分析。结果：本组病例接受椎弓根内固定术的并发症的发病率为17．3％。固定节段错误2例；椎弓银钉位置不良4例；过度撑开复位2例；深部感染2例；断钉及钉道松动7例；连接杆翻转1例；取内固定截瘫1例。结论：胸腰椎椎弓根钉内固定的并发症并非少见。应选择可靠的内固定物；严格地规范手术操作，加强术中X线透视监测，使手术并发症降低。     

AF系统复位固定术后松动滑脱断钉的原因分析

目的：探讨脊柱胸腰段骨折脱位AF系统复位固定术后，出现松动、滑脱、断钉的原因。方法：自1996年8月－2000年10月，112例应用AF系统治疗的胸腰段骨折或脱位患者中，获得随访95例，16例发生松动、滑脱及断钉，其中螺钉松动7例，滑脱3例，断钉6例（9枚螺钉）。结果：AF系统复位内固定术后松动、滑脱、断钉的原因有以下几方面：（1）解剖学的特点；（2）患椎因素；（3）椎间盘因素；（4）AF系统的设计缺陷；（5）患者因素；（6）技术因素。结论：术前根据患椎的具体情况，制定完善的手术方案，精确的手术操作，合理的术后功能锻炼，尽量避免上述因素的影响，是降低AF系统内固定失败发生率的有效手段。     

GSS系统治疗胸腰椎骨折并发症及防治

[目的]分析总结GSS（general spine system，GSS）系统治疗胸腰椎骨折时出现的并发症及其原因，以期找到更好的预防措施，减少治疗过程中并发症的发生。[方法]回顾性分析自2003年1月-2005年12月在本科接受胸腰椎骨折GSS系统内固定手术的83例患者治疗情况，术后所有患者均获得随访，平均随访时间22个月。[结果]并发症发生15例，发生率18．1％，其中定位错误3例，GSS螺钉进入椎间隙2例，椎体高度撑开不足4例，脑脊液漏1例，钉道松动2例，断钉2例，术后感染1例。分析并发症发生原因，主要为：（1）术前准备不充足；（2）患椎解剖结构变化；（3）GSS系统的设计缺陷；（4）技术因素。[结论]术前根据患椎的具体情况，制定完善的手术方案，术前准备工作充分，以及精确的手术操作，合理的术后康复过程，是降低GSS系统内固定失败发生率的有效手段。     

伤椎椎弓根钉固定在胸腰椎骨折中的应用

目的探讨后路伤椎椎弓根钉固定治疗胸腰椎骨折的疗效。方法应用伤椎椎弓根钉固定治疗胸腰椎骨折患者26例。结果患者均获随访,时间3～31（22±5.2）个月,骨折愈合时间2.2～3.8（2.8±0.4）个月。骨折椎体复位好,胸腰椎间融合好,Cobb角无明显改变,无发生侧方移位。结论伤椎椎弓根钉固定治疗胸腰椎骨折具有固定可靠,易于维持椎体高度及避免侧方移位的优点。     

Cage联合钉棒系统治疗腰椎滑脱症疗效观察

目的:观察后路Cage融合联合钉棒系统内固定治疗腰椎滑脱症的临床疗效。方法:选取接受后路Cage融合联合钉棒系统内固定术治疗的腰椎滑脱症患者67例,回顾分析其临床资料,统计腰椎JOA评分、VAS评分、临床优良率,以及手术并发症,评价其临床疗效。结果:67例患者手术均顺利完成,术后均获得随访,随访时间34~67个月,平均46.6个月。与术前比较,术后及末次随访JOA评分、VAS评分,差异有统计学意义(P0.05);与术后比较,末次随访JOA评分、VAS评分,差异有统计学意义(P0.05)。随访过程中,未发现病变复发、局部感染、内固定松动、Cage融合器移位等并发症。结论:采用后路Cage融合联合钉棒系统治疗腰椎滑脱症临床疗效确切,内固定牢固,复发率低,能够明显改善患者的临床症状,提高患者生活质量。     

Complications with the variable spinal plating system

From January 1986 to June of 1987, 40 patients underwent transpedicle fixation and fusion using the variable spinal plate system. Nineteen patients had undergone surgery at the same level or levels, and 21 patients had undergone no previous surgery. Diagnostic categories include spondylolisthesis, thoracolumbar and lumbar fractures, internal disc derangement, spinal stenosis, pseudarthrosis, mechanical instability, and fracture mal-union. Minimum follow-up has been 14 months, with the average being 20 months. Overall results showed 13 excellent, 12 good, seven fair, and eight poor. The overall complication rate was 45%. In those patients undergoing no previous surgery, it was 29%, but with those patients having previous surgery, it was 63%. Most of these complications were minor in nature and resolved before discharge. Implant failure occurred in seven patients, and consisted of screw breakage. Design modifications currently available should help minimize this complication. Although this method of internal fixation and fusion is technically demanding and has a high complication rate, it is considered to be indicated in lumbar fractures, revision of pseudarthrosis, spondylolisthesis with or without reduction, and failed surgery with marked instability.     

后路短节段内固定结合椎体成形术治疗老年胸腰椎骨折57例疗效分析

目的总结后路短节段内固定结合椎体成形术治疗老年胸腰椎骨折的临床疗效。方法 2010年3月~2012年2月共收治57例老年胸腰椎骨折患者,年龄60~74岁,均采用后路短节段内固定结合椎体成形术治疗。结果 57例患者均获随访,时间12~20月,均未出现伤口感染、断钉等并发症。术后伤椎椎体前缘高度压缩率及Cobb角均较术前显著改善(P0.05),但末次随访与术后1周比较无统计学差异(P0.05)。末次随访时Frankel神经功能评分:D级9例,E级48例;术后ODI评分:优16例,良27例,可14例,优良率75.4%。结论后路短节段内固定结合椎体成形术治疗老年胸腰椎骨折可有效恢复椎体前缘高度,纠正Cobb角,且能避免恢复高度的丢失,效果满意,值得临床推广。     

Scoliosis associated with lumbar spondylolisthesis: a case presentation and review of the literature.

BACKGROUND CONTEXT: The association between scoliosis and spondylolisthesis is well documented, but criteria and methods for managing the deformity in patients with debilitating pain are not clear. PURPOSE: To describe correction of scoliosis by internal fixation of the spondylolisthesis. STUDY DESIGN: Case report of a patient with scoliosis developing in association with spondylolisthesis. METHODS: A 17-year-old female presented with a 6-month history of back and leg pain. No spinal curvature was noted in radiographs taken at the onset of symptoms. Significant curvature appeared during the 6-month history of pain in association with an L5-S1 spondylolisthesis. The spondylolisthesis was repaired with posterior pedicle screw instrumentation. RESULTS: The pain and the spinal curvature almost completely resolved after surgery, and the outcome remained excellent 14 months after surgery. CONCLUSION: In the properly diagnosed patient, surgical repair of the spondylolisthesis can relieve pain and correct spinal curvature.     

带预警装置椎弓根螺锥的临床应用

目的探讨带预警装置椎弓根螺锥在胸腰椎手术应用中的优越性。方法回顾性研究自2010年9月~2011年10月收治的需进行椎弓根钉系统内固定的胸腰椎疾病30例,其中腰椎间盘突出16例,胸腰椎骨折10例,椎体滑脱4例。在减压解除神经压迫或复位椎体的同时利用带预警装置椎弓根螺锥行椎弓根钉固定。结果共置入160枚螺钉,术中及术后X线片评估椎弓根钉置钉准确度为100%,术后三维影像评估螺钉位置准确率为94.4%,螺钉平均置入时间(4.5±0.7)min/枚,未出现螺钉置入相关的近期并发症。结论在胸腰椎手术中应用带预警装置椎弓根螺锥行椎弓根钉置入,可有效提高置钉的精确性、安全性,缩短手术时间、减少术中出血量及放射线的暴露强度。     

Early results of spinal fusion using variable spine plating system

Seventy-seven consecutive patients underwent application of variable spine plating (VSP) spinal plates between August 1984 and October 1985. Sixty-four percent had previous procedures at the same level or levels operated. Operative indications were spinal stenosis, segmental instability, unstable spondylolisthesis, herniated disc with instability, pseudoarthrosis, unstable fracture, and failed surgery syndrome with evidence of one of the preceding. Overall results showed 30% excellent, 30% good, 34% fair, 6% poor. There were four deep wound infections and 19 patients with one or more broken screws. Screw alignment and the angular relationship of each screw to the spinal plate are considered important technical factors in minimizing screw failure. Vigorous distraction of the vertebrae using interpedicular screws is rarely indicated. Twenty-four patients required reoperation. We feel the procedure is relatively indicated in cases of moderate to severe instability, such as some cases of spondylolisthesis, failed surgery with marked segmental instability, the obese, deconditioned patient, or cases of spinal stenosis rendered very unstable by surgical decompression, and most strongly indicated in unstable lumbar and thoracolumbar fractures.     

胸腰段Chance和屈曲分离型骨折诊治探讨

目的：探讨chance和屈曲分离型胸腰椎骨折受伤机制、诊治方法；方法：回顾性分析12例屈曲分离型胸腰椎骨折的诊治过程，随访采用经椎弓根内固定的钉杆系统后路加压的手术治疗效果；结果：神经和愎部损伤的发生率与国外报道相比少见，绝大多数患者为不稳定骨折，术后患者病椎达到即刻三维复位稳定，缩短了住院和卧床时间．随访8～21个月(平均14个月)，无1例椎体塌陷和后凸畸形，取得良好的疗效。结论：chance和屈曲分离型胸腰椎骨折经椎弓根内固定的钉杆系统手术治疗，疗效满意。     

一期前路椎体间植骨并内固定治疗胸腰椎结核

目的　探讨脊柱结核外科治疗中一期重建脊柱稳定性的重要性及内固定器械植入的安全性。　方法　总结 1997年 10月至 1999年 1月期间收治 11例胸腰椎结核患者 ,采用一期前路病灶清除、椎体间自体植骨并胸腰椎“Z”形前路钛钢板内固定治疗。　结果　经平均 16个月的随访 ,11例患者脊柱结核均治愈 ,无局部结核复发 ,植骨全部骨性融合 ,融合时间平均为 3.8个月 ,后凸矫正角度 18° ,无手术并发症。　结论　早期重建脊柱稳定性在脊柱结核外科治疗中具有重要的意义 ,在结核病灶局部植入钛质内固定器械是安全和有效的。     

短尾万向联合长尾单向椎弓根螺钉在峡部裂性腰椎滑脱症中的应用

目的探讨短尾万向及长尾单向椎弓根螺钉复位内固定系统结合椎体间植骨融合治疗峡部裂性腰椎滑脱症的临床效果。方法 2010年6月至2012年1月郑州市骨科医院采用短尾万向及长尾单向椎弓根螺钉复位内固定系统结合椎体间植骨融合治疗74例峡部裂型腰椎滑脱症患者,术后3、6个月行腰椎CT平扫＋二维重建检查,评价滑脱复位、椎间隙高度和植骨融合情况;术后6个月采用Beaujon功能评分（BFS）进行疗效评估。结果手术时间90~135 min（平均112 min）,出血量300~750 mL（平均420 mL）。术中未发生马尾、神经根损伤,1例出现硬脊膜撕裂继发脑脊液漏。所有患者获有效随访,随访时间6~12个月,平均随访时间8.1个月。术后3、6个月滑脱椎体复位率和植骨融合率分别为（93±5）%、（91±4）%和81%、100%;术后6个月BFS较术前明显改善（P〈0.05）,BFS好转率为（79±4）%,优51例、良16例、中6例、差1例,优良率为91%（67/74）。随访期间滑脱复位程度和椎间隙高度无明显丢失。结论短尾万向及长尾单向椎弓根螺钉复位内固定系统结合椎体间植骨融合治疗峡部裂性腰椎滑脱症,植骨融合率高,并发症少,滑脱复位满意。     

Treatment of unstable thoracolumbar and lumbar spine injuries using Cotrel-Dubousset instrumentation

STUDY DESIGN: In this prospective study, the results of treating unstable thoracolumbar and lumbar injuries with Cotrel-Dubousset instrumentation were investigated. OBJECTIVE: To determine the pain and work status of the patients, to evaluate neurologic status, and to assess the efficacy of instrumentation in the short term. SUMMARY OF BACKGROUND DATA: Short-segment pedicle screw construct is the method of choice for reduction and stabilization of unstable thoracolumbar spinal injuries. Many investigators have recently reported a high rate of instrument failure. In this study, the use of segmental transpedicular fixation two levels above the kyphosis decreased instrument failure and sagittal collapse. METHODS: Thirty patients, who had unstable thoracolumbar and lumbar spinal injuries, underwent application from a posterior approach of Cotrel-Dubousset instrumentation two levels above and one below at the thoracolumbar junction and short segment fixation in the lumbar area. Radiologic parameters were evaluated before and after surgery. RESULTS: The mean follow up was 31 months (range, 25-49) months. There were statistically significant differences between the pre- and postoperative values in all radiologic parameters. Neurologic status improved in 70% of the patients, with a mean Frankel grade of 1.3 grades. CONCLUSIONS: Cotrel-Dubousset instrumentation provided spinal stability in unstable injuries, forming a rigid construct and restoring physiologic thoracolumbar and lumbar postural contours because of its highly corrective effect in the sagittal profile with no loss of correction.