椎弓根内固定技术的并发症分析

Complications Associated with the Technique of Pedicle Screw Fixation

目的分析治疗脊柱疾病的椎弓根内固定手术在术中、术后发生并发症的原因,以便提出防治措施。方法对本科1988～1999年采用椎弓根内固定技术治疗脊柱疾病的475例患者的资料进行回顾性总结并结合随访结果进行统计、分析。结果428例获随访(占90.1%)。术中并发症26例,发生率5.5%;术后并发症64例,发生率15%。并发症主要发生在采用CD、DRFS、Dick、RF及Steffee等5种椎弓根内固定技术时,共72例,占总并发症例数的80%。上述5种椎弓根内固定技术的术中/术后并发症发生率依次为:CD技术0～12.9%、DRFS技术6.8%～11.9%、Dick技术7.3%～12.7%、RF技术2.4%～19.5%、Steffee技术10.1%～21.5%。主要并发症包括假关节、椎弓根螺钉断裂、椎弓根螺钉位置不正确等。引起并发症的主要原因包括对椎弓根内固定技术掌握不熟练、内植物设计本身存在的缺陷等。结论椎弓根内固定技术的并发症不容忽视,引起并发症主要原因是椎弓根内固定技术熟练程度不够及内植物本身设计上的缺陷。

Objective To analyze the causes of the complications associated with the pedicle screw fixation during and after operation,as well as the methods for prevention and treatment.Methods From January1988to December1999,475patients who underwent pedicle screw fixation for various spinal disorders were reviewed retrospectively with statistical analysis.Results Four hundred and twenty-eight patients(90.1%of all)were followed up for(6.0±3.7)years.Complications of CD,DRFS,Di ck,RF and steffee among72cases (80%of all)occurred during the operation of pedical screw fixation in26cases with the incidence of5.5%and after the operation in64cases with the incidence of15%.The incidences of operative/postoperative complications were0～12.9%in CD,6.8%～11.9%in DRFS,7.3%～12.7%in Dick,2.4%～19.5%in RF,and10.1%～21.5%in Steffee respectively.The main complications included pseudoarthrosis,pedicle screw broken,pedicle screw malposition and so on.The complications were mainly due to unskilled technique of pedicle screw fixation,implant defect in design and so on.Conclusions The complications associated with the technique of pedicle screw fixation must not be neglected.The main causes are laid on unskilled technique of pedicle screw fixation and implant defect in design