生物力学角度分析胸腰段脊柱骨折内固定断裂原因及预防措施

目的：从生物力学角度探讨临床工作中遇到的胸腰段脊柱骨折内固定术后断裂的原因及预防措施.方法：回顾性分析2007～2012年临床工作中所遇到的共计19例脊柱内固定断裂病例,从内固定位置、形态、进钉角度等方面,结合人体脊柱生物力学研究成果进行分析总结.结果：经分析认为脊柱内固定系统断裂的主要原因包括：①未能根据生物力学重建的需要选择最佳的内固定器材;②术中操作不当;③骨折部位未行必要的植骨;④内固定留置体内时间过长.结论：为了预防和减少脊柱内固定材料断裂,术前对患者病情应当进行充分的评估,根据生物力学稳定性重建的需要来选择恰当的手术方式和适当的内固定材料;必要时应在术中一期植骨,有利于重建其稳定性;此外术后康复期佩戴适当的外固定支具,也对临床治疗有重要意义.

Biomechanical Analysis for the Causes and Preventive Measures of Implant Rupture in Thoracolumbar Spine Fracture Internal Fixation

Objective：This research studies the causes and preventive measures for implant-rupture in thoracolumbar fracture internal fixation from the angle of biomechanical in clinical cases. Methods ： By reviewing the 19 clinic cases of spine internal fixation rupture during 2007 - 2012, studied internal fixation positions, shapes and entrance angles of pedicle screw, combined with research progresses on human spinal biomechanics, concludes few major causes for spinal internal fixation system ruptures. Results：The major causes： （1） Improper internal fixation equipments chosen for spinal biomechanics reconstruction; （2）improper operation during surgeries; （3）necessarily bone graft for fracture position have not implanted; （4）internal fixation stays inside body too long. Conclusions ：To prevent and reduce spinal internal fixation rupture, fully assessments of patient＇s condition and requirements for biomechanics stable reconstructions are needed to choose proper surgery methods and internal fixation materials. Necessary bone graft during surgery benefit for stable reconstruction. Moreover, wearing appropriate external fixation brace during rehabilitation after surgery also have significant mean for clinical treatment.