胸腰椎骨折椎弓根内固定术后失败原因探讨

目的 探讨胸腰椎骨折后路内固定术后发生内固定松动、脱落和断裂的危险因素,并分析防治对策.方法 回顾性分析2003年1月至2006年1月收治且定期随访至少2年的胸腰椎骨折后路固定术患者625例,男401例,女224例;年龄15～58岁,平均32.8岁.植骨融合者389例,末植骨融合者236例.分析625例患者的影像学资料和临床住院病历,两者结合判断内同定松动、脱落和断裂的发生情况.结果 共21例椎弓根内固定治疗失败,失败率为3.36%.内固定失败者包括胸腰段14例.腰段7例.其中椎弓根螺钉断裂者15例,连接杆断裂者1例,内固定松动者3例,螺帽脱落者2例.内固定失败平均时间1.97年.植骨融合者失败率为1.03%,未植骨融合者失败率为7.20%,两组差异有统计学意义(χ2＝3.92,P＜0.05).结论 胸腰椎骨折后路内固定术后失败多见于胸腰段骨折者.术中有效植骨叮降低内固定失败发生率,爆裂骨折内固定应尽量联合椎间和横突间植骨.骨折术后系统全面的康复治疗、避免过早重体力劳动对避免内固定失败有重要作用.

The analysis of failure of thoracolumbar vertebral fracture patients used in the pedicle screw fixation system

Objective To analysis the possibilities which have caused posterior pedicle screw loosen, break and other failures found in the thoracolumbar vertebral fracture patients, and analysis the strategy.Methods This retrospectively review contained 625 patients suffered thoracolumbar vertebral fracture who was treated in our hospital and completed the follow-up period for at least 2 years.There are 401 males and 224 females, with the mean age of 32.8 years, ranged from 15 to 58 years, and 389 patients with bone graft, 236 patients without bone graft.All the 625 patients' complete X-ray records as well as patients records were analyzed.The diagnosis of failure should be supported by both patient records and X-ray image records.All these patients' operation records were reviewed to identify whether the patients have the bone grafting during the operation.Results There were totally 21 patients experiencing the pedicle screw fixation system failure, which included thoracic-lumbar conjunction region in 14 patients and lumbar region in 7 patients.The failure rate was 3.36%.The pedicle screw break was found in 15 patients, the connection rod break in 1 patient, the looseness of the system in 3 patients, and the female screw shedding in 2 patients.The failure time was 1.97 years in average.The failure rate in bone grafting patients group was 1.03%, while in the group of without bone grafting patients was 7.20%; there was a significant difference between two groups(x2=3.92,P<0.05).Conclusion There is no difference between the thoracic-lumbar conjunction region and the lumbar region.Effective bone grafting can help the system to get a good result and avoid failure.For the burst vertebral fracture patients, both posterolateral and transverse bone grafting should be performed.The systematic rehabilitation and avoidance of heavy labor postoperatively can be helpful in achieving a good result.