胸腰椎损伤手术治疗失误原因分析

目的：分析胸腰椎损伤手术治疗失误的原因及对策。方法：1997年5月～2001年5月收治因手术失误而再次手术的63例，通过临床检查结合影像学X线平片、CT或MRI检查，对初次手术失误的原因进行评估分析。结果：63例初次手术失误原因，可分为二类：(1)手术方法选择失误：包括前、后路术式选择不当4例，椎管减压术应用不当8例，内固定器械选择不当5例；(2)手术技术应用不当，包括脊柱骨折复位不良29例，椎管减压不彻底28例，内固定技术不良32例，术中可疑伤及脊髓5例。结论：对胸腰椎损伤手术治疗需正确选择术式及正确应用减压及内固定技术。

Analysis of Failed Primary Surgical Treatment of Thoracolumbar Fracture

Objective: To find out the cause of failed primary surgical treatment of thoracolumbar fractures.Method:Sixty-three cases of thoracolumbar fracture received secondary operation,reasons of failed primary surgical management were noted by physical examination,X-ray film,CT or MRI scanning.Results:The reasons accounted for failed primary surgical management in 63 cases of thoracolumbar fractures could be classified into two items:(1)mistake choose of operative methods,including incorrect spinal choose of anterior or posterior approaches in 4 cases,incorrect spinal canal decompression in 8 cases,and incorrect choose of spinal instrumentation in 5 cases;(2)incorrect use of spinal technique,including failed reduction of spinal fracture or dislocation in 29 cases,incomplete decompression of spinal canal in 28 cases,incorrect spinal instrumentation in 32 cases and suspected spinal cord injury in 5 cases.Conclusion:It is essential for spinal surgeons to choose correct surgical approaches,spinal canal decompression and spinal instrumentation techniques in order to minimize the failed primary surgical management of thoracolumbar fracture.