脊柱手术内固定失败的原因及对策

FAILURE FOLLOWING INTERNAL FIXATION OF SPINE:CAUSES AND COUNTERMEASURES

目的分析脊柱内固定手术失败的原因,探讨避免内固定失败的对策。方法 2010年1月—2011年12月,我科共实施2 200例脊柱内固定手术,得到完整随访者1 350例,对其临床资料进行回顾性分析。结果随访发现35例病人内固定术失败,其中颈椎前路钢板内固定术后钢板螺钉松动移位4例,颈椎后路侧块钢板断裂5例,颈椎后路钢板侧块螺钉松动5例,胸腰骶椎内固定椎弓根螺钉松动移位9例,螺钉断裂5例,螺钉位置不佳刺激神经根4例,内固定感染3例。内固定术失败主要表现为畸形、局部疼痛和异常响动、肢体疼痛麻木、发热等。结论脊柱内固定术失败的主要原因是术者手术技术不熟练、生物力学概念不清、植骨床去皮质不充分、植骨量不足,其他因素有感染、骨质疏松、内置物选择不当等。

Objective To analyze the causes of failure in internal fixation of spine, and explore measures to avoid it. Methods From January 2010 to December 2011, 2 200 patients underwent spinalqnternal-fixation in our department of whom, 1 350 were completely followed and their clinical data analyzed retrospectively. Results Failures of internal fixation were found in 35 patients. The causes observed were as follows： loosening and shifting of anterior cervical locking screw-plate device （four ca ses）, broken of posterior cervical plate （five）, loosening of posterior cervical lateral mass screw （five）, loosening of pedicle screw （nine）, broken of pedicle screw （five）, nerve root was excited due to unfit location of the screw （four） and infection （three）. The manifestations were deformity, localized pain, abnormal sound, limb numbness or pain, or fever. Conclusion The main causes of failure of spine internal fixation operation include unskilled surgical technique, incomprehension of biomechanical concept, insufficient decortication of bone graft bed, no enough bone graft, and others such as infection, osteoporosis and ill suited internal fixation devices.