后路椎弓根螺钉固定治疗胸腰椎骨折的并发症的防治

Prevention and treatment of complications after surgical therapy for thoracolumbar fracture with posterior pedicle screw fixation

目的回顾分析应用椎弓根螺钉固定技术治疗胸腰椎骨折发生的并发症原因，探讨其防治方法。方法回顾分析2003年4月-2006年10月应用椎弓根螺钉固定技术治疗胸腰椎骨折的患者486例，共发生各类手术并发症45例，针对不同原因采取相应补救方法，观察术后疗效并探讨预防措施。结果早期手术并发症13例，包括切口感染5例、椎弓根螺钉位置不良6例及下肢深静脉血栓形成2例；晚期并发症32例，包括椎弓根螺钉断裂20例、椎弓根螺钉松动4例、连接杆断裂3例、钉杆连接松动3例、神经减压不彻底2例。其中20例进行内固定翻修手术，更换椎弓根螺钉12例，更换连接杆3例，调整紧固钉杆连接装置3例，再次前路减压2例。结论椎弓根螺钉固定技术治疗胸腰椎骨折的并发症的发生主要与手术操作不当、忽视植骨融合的质与量以及手术方式选择错误有关，再次手术只要处理方法得当仍能取得满意疗效。

Objective To analyze the causes of postoperative complications of thoracolumbar fracture after posterior pedicle screw fixation, and find out an effective way to prevention and treatment. Methods From April 2003 to October 2006, 486 patients who suffered from thoracolumbar fracture underwent posterior pedicle screw fixation. Among the patients, 45 cases with different complications in whom 20 cases underwent revision operations were retrospectively analyzed. All complications were handled according to the different causes. Then the postoperative curative effects were observed and the prophylactic measures were discussed. Results Thirteen early complications included 5 cases with deep incision infections, 6 cases with misplacement of pedicle screw and 2 cases with deep vein thrombosis. Thirty-two late complications included 20 cases with pedicle screw breakage, 4 cases with pedicle screw loose, 3 cases with rod breakage, 3 cases with connection loose between screw and rod and 2 cases with no complete decompression of spinal canal. Twenty patients with the complications were operated again. The revision methods included broken screws and rod remove, new screws and rod replacement, and spinal canal decompression by anterior approach. All cases with revision operations had no loss of fracture reduction, no loose and failure of pedicle screw with rod again after the reoperation. Conclusion The main causes of the postoperative complications have relationship with surgical manipulation, operative technique and the quantity and quality of bone graft. And the good outcome can be gained again with rational revision technique.