胸腰椎半椎体畸形后路矫形节段内固定松动失效原因分析及翻修术.DOCVIP

临床医学论文-胸腰椎半椎体畸形后路矫形节段内固定松动失效原因分析及翻修术 【摘要】? 探讨胸、腰椎半椎体畸形后路矫形节段内固定的松动、失效原因，并分析翻修术的疗效及策略。［方法］回顾性分析本院收治的胸、腰椎半椎体畸形后路矫形节段内固定的松动、失效患者7例，其中男3例，女4例；年龄1.8～13岁。就诊时术前侧弯Cobbs角平均34.1°，后凸平均为40.2°。均行后路翻修术。［结果］初次手术未切除孤立单发的半椎体4例，固定及融合节段过短5例，术中对幼儿矫形操作不当2例，内固定选择不佳2例，术中未植骨融合1例。本组术后侧弯Cobbs角平均12.6°，矫形率63.0%。后凸Cobbs角术后17.3°，矫形率56.9％，随访18~28个月，获得矫形无丢失，植骨融合良好。无感染、脊髓神经损伤、内固定失败。［结论］未切除孤立单发的半椎体、固定及融合节段的策略失误、术中对幼儿矫形操作不当、内固定选择不佳、术中未植骨融合的影响是初次术后内固定的松动、失效原因。在翻修术中避免以上5种原因而制订策略，临床疗效满意。 【关键词】? 胸椎 腰椎 先天性脊柱侧凸 半椎体 内固定器 翻修术 ?????? Abstract：［Objective］To evaluate the factors causing loosening of instrumentation and the progressive deformities after treating thoracolumbar bemivertebra with segmental instrumentation,and analyze the outcomes and strategies of reversion.［Method］A retrospective study was made in 7 cases with loosening of instrumentation and the progressive deformities secondary to operation on thoracolumbar hemivertebra in our hospital.There were 3 males and 4 females,with age range of 1.8~13 years.Preoperative mean Cobbs angles of scoliosis was 34.1°,and kyphosis was 40.2°.All cases were treated with posterior reversion.［Result］The failure factors of primary surgery were resulted from:failure of single hemivertebra resection（4 cases）,shortage of segments fixation and bone graft（5 cases）,unsatisfactory selection of instrumentation（2 cases）,failure of manipulation in young children（2 cases）,segment fixation without fusion（1 case）.Postoperative mean Cobbs angle of scoliosis was 12.6°,with correction rate of 63.0%,and kyphosis was 17.3°,with correction rate of 56.9%.The revision cases were followed up for 18 to 28 months and showed that all patients got satisfactory cosmetic correction and fine fusion.No neurological complication or infection occurred,no implant failure were verified at the final radiographic evaluation.［Conclusion］The reasons for postoperative loosening of instrumentation and the progressive deformities includs:free from hemivertebrectomy,inappropriate segments fixation and