胸腰段骨折椎弓根螺钉折断原因分析

目的寻求胸腰段骨折椎弓根螺钉内固定失败的原因和对策。方法随访观察108例胸腰椎骨折采用后路切开复位椎弓根螺钉系统内固定术治疗的患者,发现108例术后患者中有11例发生椎弓根螺钉断裂。结果椎弓根螺钉内固定折断原因为局部应力集中及异常活动,多为技术因素。结论导致术后发生椎弓根螺钉断裂的相关因素有：①胸腰段是断钉的好发部位;②脊柱骨折的严重程度;③术中是否行椎板减压、椎弓根螺钉置入是否准确、是否有过度撑开、骨折节段是否植骨融合;④内置物留置体内时间过长;⑤术后是否严格佩带支具;⑥椎弓根螺钉本身的设计缺陷。

Analysis of correlation reasons on pedicle screw fixation operation for thoracolumbar fractures

Objective To analyze the causes of failure of thoracolumbar fractures treated with internal fixation,and to develop a prophylactic methods.Methods 108 patients suffering with thoracic and lumbar vertebra fractures were treated by open reduction from back and internal fixation with screw system of vertebral arch pedicle.Among the 108 patients,11 suffered with breaks of screws.Results We considered that the causes of spinal internal fixation broken were stress concentration and abnormal movement of internal fixation,and was mainly relative to poor techniques.Conclusion the related factors involved in pedicle screw break after internal fixation operation for fractures of thoracic and lumbar vertebrae include：①The thoracic and lumbar vertebrae segment in favour of screw breaks.②The serious degree of the spine fracture.③Wether or not of vertebral plate decompression,correction of the direction of vertebral arch screws in two sides,being over braced,and bone graft fusion.④Detention time inside the body of the implement overlong.⑤Whether the engirded orthosises strictly or not.⑥The defects in design of vertebral arch pedicle screws.