侧前方钉板系统治疗胸腰椎骨折的并发症分析

Complications of thoracolumbar fractures fixed with latero-anterior screw-plate system

目的分析侧前方钉板系统治疗胸腰椎骨折的手术并发症发生原因并探讨其防治方法。方法回顾2000年1月-2006年12月采用侧前方钉板系统治疗的胸腰椎骨折出现并发症的30例患者的病例资料，通过临床检查结合X线片、CT或MRI检查，对手术并发症的发生原因进行评估分析并探讨其防治方法。结果术后随访3个月-6年，平均15．1个月。本组患者螺栓方向欠佳8例，螺栓长度偏短10例，螺钉松动2例，断钉1例，钢板长度过长4例，钢板断裂1例，术后轻度脊柱侧凸畸形9例，轻度后凸畸形2例。结论根据胸腰椎局部解剖标志及解剖特点判断术中进钉点及进钉方向，必要时透视或摄X线片定位定向；重视术前必要指标测量在术中的重要参考作用；两侧对称撑开，恰当植骨；术后避免过早负重是减少并发症行之有效的办法。

Objective To analyze the complications of thoracolumbar fractures fixed with lateral anterior screw-plate system and put forward countermeasures. Methods The 30 patients with thoracolumbar fractures who had been treated with anterior decompression, bone grafting and internal fixation from January 2000 to December 2006 and presented with complications were chosen for this study. Their clinical data were analyzed, including clinical exams, preoperative and postoperative X-ray, CT scanning and MRI images, to find out the causes of complications and put forward countermeasures. Results The complications in this group were caused by inappropriate direction of vertebral screw （8 cases）, insufficient length of vertebral screw （10 cases）, screw loosening （2 cases）, plate break （1 case）, extra length of plate （4 cases）, screw break （1 case）, postoperative slight scoliosis （9 cases） and slight anterior curvature （2 cases）. Conclusions The entry point and direction of the screw should be determined exactly by anatomic landmarks and characteristics of the thoracolumbar vertebrae and checked by X-ray. Essential data must be measured on the X-ray films and CT scanning carefully before operation. Symmetrical brace and appropriate bone graft should be ensured during operation and early weight loading should be banned after operation.