经皮微创复位内固定术治疗胸腰椎骨折的并发症

目的总结经皮微创复位内固定术治疗胸腰椎骨折术中及术后并发症发生情况,并分析其原因。方法 2012年2月—2015年2月,采用后路经皮微创椎弓根螺钉内固定术治疗且随访资料完整的胸腰椎骨折患者742例,其中男425例,女317例;年龄17～60(41.9±8.6)岁;损伤节段:T11 82例,T12 227例,L1 231例,L2 93例,L3 69例,L4 40例。AO分型:A1型262例、A2型95例、A3型335例、B1型41例,B2型9例。详实统计并分析术中、术后并发症的发生情况及其原因。结果所有患者随访11～36(22.9±5.8)个月。共46例发生并发症(6.2%),其中术中并发症7例,包括导丝断裂3例,腹主动脉损伤1例,硬膜损伤3例;术后并发症39例,包括螺钉位置不良17例(共19枚钉),螺钉断裂8例,螺塞脱落2例,连接棒松动3例,复位不良4例,迟发性感染5例。7例术中并发症患者经术中及时处理,手术顺利完成;39例术后并发症患者中14例行手术翻修,其余患者给予支具等辅助治疗,术后恢复良好。结论经皮微创复位内固定术治疗胸腰椎骨折术中及术后并发症包括感染、血管损伤、螺钉位置不良、复位欠佳、内固定失败等,其中最常见的并发症为螺钉位置不良,其发生率为2.29%(17/742);并发症发生主要原因为手术误操作,占52.2%(24/46)。

Complications of minimally invasive percutaneous reduction and internal fxation for thoracolumbar fractures

Objective To summarize the complications of percutaneous minimally invasive reduction and internal fixation in the treatment of thoracolumbar fractures and discuss the underlying causes of these complications.Methods From February 2012 to February 2015, 742 patients with thoracolumbar fractures were treated with posterior percutaneous minimally invasive pedicle screw fixation. There were 425 males and 317 females with the age of 17-60(41.9±8.6) years old. The involved segments included T₁₁ in 82 cases, T₁₂ in 227, L₁ in 231, L₂ in 93, L₃ in 69 and L₄ in 40. According to AO classification, A1 type was seen in 262 cases, A2 type in 95, A3 type in 335, B1 type in 41 and B2 type in 9. The occurrence and causes of intraoperative and postoperative complications were analyzed statistically.Results All the patients were followed up for 11-36(22.9±5.8) months. There were 46 patients presenting with complications(5.9%), including intraoperative complications in 7 and postoperative complications in 39. Intraoperative complications included 3 of guide wire feature, 1 of abdominal artery injury and 3 of dural injury. Postoperative complications included pedicle screw misplacement in 17 cases(19 screws in total), screw breakage in 8, nut falling off in 2, connecting rod loosening in 3, poor reduction in 4 and flate infection in 5. Seven cases with intraoperative complications were treated in time, and the operations were completed successfully. Of the 39 patients with postoperative complications, 14 underwent surgical revision, and the remaining received braces and other adjuvant treatments, and the postoperative recovery was good.Conclusion Percutaneous minimally invasive reduction and internal fixation for treating thoracolumbar fractures has many intraoperative and postoperative complications, such as infection, injury to blood vessels, pedicle screw misplacement, malreduction and internal fixation failure. Pedicle screw misplacement is the most common complication with an incidence rate of 2.29%(17/742), and its main cause is misoperation during the surgery with an incidence of 52.2%(24/46).