首次手术失败的胸腰椎陈旧性骨折再手术分析

Analysis about Reoperation of Old Thoracolumbar Fractures Failed in the First Operation

目的 :探讨首次手术失败的胸腰椎陈旧性骨折再手术的意义。方法 :9例首次手术失败的胸腰椎陈旧性骨折经原内固定拆除 ,前路减压、撑开复位、取髂骨植骨、“Z”形钢板内固定治疗。并对其结果进行临床和影像学检查评价。结果 :本组病例均经随访 ,植骨于术后 3～ 4个月骨性融合。恢复之椎间高度不发生再丢失 ,胸腰椎生理弧度良好 ,无继发性后凸畸形发生。无钢板、螺钉折断、松动及滑脱等并发症。所有病例至少有Frankel 1级以上的功能恢复。结论

Objective: To investigate the clinical significance about reoperation of old thoracolumbar fractures failed in the first operation.Methods:All nine patiens were dismantled internal fixation,anterior decompression,reduced and planted with ilium and internal fixation with a 'Z' plate, the result were analyzed with clinic and radiography.Results:All patients were followed up for an average of one year and seven months(6-36months).Solid fusion was observed in 3～4 months.No Complications were happened.the lower back pain and neurological deficits were improved or disappeared,The kyphotic angle was an average of 7.7degree(-3～10degree).Conclusions:Anterior decompression and spinal reconstruction allow for effective decompression of neural stuctures,promote arthrodesis and correct kyphotic deformity.It is demonstrated to be a safe and effective technique for the management of delayed thoracolumbar instability after old vertebral fractures failed in the first operation.