胸腰段骨折椎弓根螺钉折断原因剖析.docVIP

胸腰段骨折椎弓根螺钉折断原因剖析 　　【摘 要】 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。 　　?【关键词】 胸腰椎骨折；椎弓根螺钉固定术;折断 　　 　　Analysis of correlation reasons on pedicle screw fixation operation for thoracolumbar fracturesLI Peng-fei,BI Wei． Central Hospital of Dalian City, Liaoning Province, Dalian 116000,China?【Abstract】 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． 　　【Key words】 Thoracic lumbar vertebrae；Pedicle screw fixation；Broken 　　 　　胸腰椎骨折是临床常见的创伤，椎弓根螺钉内固定术得到广泛的临床应用,它能同时固定脊柱前、中、后柱,且仅涉及病椎上、下椎体的优点,手术创伤小、复位满意、安全简便等。但随着该项技术的广泛应用,其手术失败的病例越来越多,特别是椎弓根固定系统断裂，已成为脊柱外科医生不能忽视的问题。1999年7月至2006年7月我院采用椎弓根螺钉系统内固定术治疗胸腰椎骨折108例，术后随访发现断钉11例。笔者从临床角度回顾性分析其断裂的原因,以提高手术成功率。 　　 　　1 对象与方法 　　 　　1．1 对象 1999年7月至2006年