AF治疗胸腰椎骨折术后椎弓根螺钉断裂的原因及对策

Causes and countermeasures of pedicle screws rupturing after internal fixation with AF systems for thoracolumbar fractures

目的探讨采用内固定治疗胸腰椎骨折术后椎弓根螺钉断裂的原因及对策。方法回顾分析82例胸腰椎骨折采用AF椎弓根螺钉系统内固定,其中胸119例,胸1231例,腰124例,腰25例,腰33例。结果有11例出现断裂,发现时间术后5~38个月,平均15个月。椎体高度丢失19.8%。造成螺钉断裂的原因：①椎弓根螺钉自身的缺陷;②椎弓根螺钉负荷过大;③椎间盘退变;④手术操作不规范;⑤植骨未愈合或未植骨;⑥内置物取出过迟;⑦术后未佩戴支具或佩戴时间过短。结论合理选择手术适应证,选择合理的椎弓根螺钉,严密的手术操作,有效的植骨融合,尽早取出内置物以及术后常规佩戴支具能有效防止椎弓根螺钉断裂。

Objective To explore the causes of pedicle screws rupturing after internal fixation with AF systems for thoracolumbar fractures and to develop the prevention measure.Methods 82 cases of thoracolumbar fractures treated with internal fixation with AF systems,from October 1998 to July 2004 reviewed,including 9 in T11,31 in T12,24 in L1,5 in L2,3 in L3.Results There were 11 causes of pedicle screws rupturing,following up for 5 to 38 months（avg.15 months）.Correction loss of vertebral body height was 19.8%.Conclusion The causes of pedicle screws rupturing could be： 1.defect of pedicle screw,2.overloading of the pedicle screw,3.degeneration of the intra vertebral,4.unstandardized operative procedure,5.bone graft was not fusion or used,6.delayed implant removal,7.no thoracolumbar protective brace had been adopted postoperatively.Countermeasure correct indication selection,fitting pedicle screw,standardized operative procedure,sound fusion by successful bone graft,timely removal of the implant and protective brace for postoperative rehabilitation are valuable procedures for prevention of pedicle screw rupturing.