胸腰椎骨折术后植入体断裂的相关因素分析

Related factors of pedicle screw break after internal fixation for thoracolumbar fractures

为了探讨胸腰椎骨折椎弓根螺钉系统内固定术后植入断钉的相关因素,随访观察1998-08/2005-08大连市第二人民医院收治,采用后路切开复位椎弓根螺钉系统内固定术治疗的215例胸腰椎骨折患者。术中行椎板减压134例,未做减压81例,行后路植骨融合149例,未做任何植骨66例。术后常规佩带支具3个月。发现215例术后患者中有22例发生椎弓根螺钉断裂,其中爆裂型骨折15例,术中行椎板减压的18例,未做任何植骨融合的16例,7例双侧进钉角度不一致,术后X射线片示5例伤椎相邻椎间隙增宽,12例伤椎上位椎间隙明显变窄,8例术后未严格佩带支具。提示导致置入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。

To study the related factors of pedicle screw break after internal fixation operation for thoracolumbar fractures, 215 patients with thoracic and lumbar vertebra fractures, who underwent open reduction from back and internal fixation with screw system of vertebral arch pedicle were selected from Dalian Second People＇s Hospital from August 1998 to August 2005. Among them, 134 patients were treated with vertebral plate decompression, and other 81 ones were not given decompression; 149 were treated with bone graft fusion, and the other 66 were not. All patients wired orthosises routinely after operation for 3 months. Among the 215 patients, 22 suffered with breaks of screws including 15 with blowout fractures, 18 were treated with vertebral plate decompression, 16 not treated with bone graft fusion, 7 with discordant screw angles of two sides, 5 with broadening intervertebral space next to the injured vertebra through X images, 12 with narrow intervertebral space close above the injured vertebra, and 8 having not wired the orthosises strictly, which suggested that the related factors involved in pedicle screw break after internal fixation operation for fractures of thoracic and lumbar vertebrae included： （1）screw breaks were always found at the thoracic and lumbar vertebrae; （2）serious degree of.spinal fracture; （3） whether the vertebral plate decompression was performed in operation or not, correction of the direction of vertebral arch screws in two sides, being over braced, and bone graft fusion; （4）overlong detention time of the implement; （5）whether the orthosises was wired strictly or not; （6） defects in the design of vertebral arch pedicle