生物活性玻璃结合椎弓根钉翻修术治疗腰椎内固定失败

Revision of Lumbar Pedicle Screw Internal Instrumentation with Bioactive Ceramic

目的探讨生物活性玻璃（商品名固骼生，NovaBone）结合椎弓根钉翻修术治疗腰椎内固定失败的临床疗效。方法自2004年1月～2006年1月共行腰椎经椎弓根内固定391例，发生内固定失败11例，其中椎弓根螺钉断裂3例，松动或退出8例。失败病例的初次诊断：L4椎体滑脱症6例，L5椎体滑脱症2例，L1椎体爆裂性骨折2例，L2椎体压缩性骨折1例，术前均有不同程度的腰腿痛症状。手术采用经椎弓根植入生物活性玻璃、重新椎弓根钉固定加腰椎后外侧植骨融合术，术后定期摄X线片，观察内固定位置、融合情况和腰腿痛症状改善情况。结果经10～25个月（平均12．3个月）随访，手术均获成功，所有切口一期愈合，无再次内固定失败，所有后外侧植骨均达到骨性融合，腰部功能恢复满意。结论生物活性玻璃结合椎弓根钉翻修术治疗腰椎内固定失败是一种安全可靠、简单有效的手术方法。

Objective To observe the clinical effect of the revision of lumbar pedicle screw internal instrumentation with bioactive ceramic （NovaBone）. Methods Eleven patients with revision of lumbar pedicle screw internal instrumentation from Jan 2004 to Jan 2006 were retrospectively studied. The primary diagnosis was L4 spondylolisthesis （6 patients） ; L5 spondylolisthesis （2 patients） ; the burst fracture （2 patients） ; the compression fracture （1 patient）. There were 8 loosing and 3 broken of pedicle screws and all the patients suffered from lumbar or leg pain. Revision methods included removal of failed screws and reinsertion of screws with posterolateral fusion. Results All the operations were successful. The mean follow- up was 12.3 months （ranged 10- 25months）. Eleven patients claimed of total disappearance of lumber or leg pain with X- ray demonstrating good implant position and excellent posterolateral fusion of lumbar. Conclnsion It is a safe and effective method of revision for treatment of the failure of lumbar pedicle screw internal instrumentation with bioactive ceramic.