椎弓根螺钉内固定治疗胸腰椎骨折断钉及弯曲松动原因分析

Analysis on the causes of pedicle screw breakage and bent in the treatment of thoracic and lumbar fractures

目的探讨胸腰椎骨折行椎弓根螺钉内固定术后断钉、弯曲松动原因及预防措施。方法对33例椎弓根内固定术后断钉、弯曲松动病例进行分析,就骨折类型、器械类型、植骨及减压等因素进行统计学分析。结果术后发生断钉、弯曲松动33例,发生率为12.5%。弯曲松动10例,断钉23例。Dick钉组1例,RF钉组15例,改良RF钉6例,AF钉组11例。植骨组7例,未植骨组26例。减压组23例,未减压组10例。爆裂型骨折21例,屈曲压缩型骨折8例,骨折脱位型4例。结论严重爆裂型椎体骨折后路椎弓根螺钉固定断钉率高,后路椎板减压、操作不当及器械本身缺陷都可增加椎弓根螺钉断钉、弯曲松动发生。

Objective To exphore the eauses of screw breakage, bent and looseness after pedicle screw fixation for thoracic and lumbar fraetures and to develop the prevention measure. Methods 33 cases of thoracic and lumbar fractures were reviewed. The statistic analysis involved fracture type, instrumentation, bone graft and decompression. Results Screw breakage, bent and looseness oecurred in 33 cases （ 12.5% ） with screw bent and looseness in 10 cases and breakage in 23. Of the 33 cases, there were 1 in Dick, 15 in RF, 6 in R and 11 in AF screws. There were 7 in bone graft and 26 in eases without bone graft; there were 23 in decompression and 10 in cases without decompression; there were 21 eases of burst, 8 fiexion-compression fractures and 4 fracture-dislocations. Conclusions The severe burst fracture is associated with high rate screw breakage. The laminectomy decompression, improper manipulation and instrumentation insufficiency can increase the occurrence of screw breakage, bent and looseness.