多棒技术在胸腰椎骨折翻修中的应用

Multi-rod constructs for revision of failed internal fixation of thoracolumbar fracture

[目的]介绍多棒技术翻修胸腰椎骨折初次术后断棒。[方法]2017年3月~2018年9月运用多棒技术行胸腰椎骨折术后断棒翻修的患者11例,沿原切口暴露断棒侧内固定物,拆除断棒后如果发现螺钉松动予以更换,必要时行伤椎置钉。于内侧置入卫星棒,分别用连接器与原始固定棒或更换后的棒相连,而且头尾侧需要各跨越至少1个节段,以形成坚强稳固的内固定,最后植骨及关闭切口。[结果]11例患者均顺利进行翻修手术,无严重并发症。末次随访时VAS和ODI评分均较术前显著减少,矢状位局部Cobb角由翻修术前(9.89±3.19)°,改善至末次随访时(-1.68±5.82)°。[结论]胸腰椎骨折术后断棒采用多棒技术翻修安全、简单,疗效显著。

[Objective]To introduce surgical technique of multi-rod constructs for revision of failed internal fixation of thoracolumbar fractures.[Methods]From March 2017 to September 2018,11 patients underwent revision surgery for rod breaking secondary to primary internal fixation of thoracolumbar fractures.Expose the implants through original incision,renew the breaking rod,if the pedicle screw was loosening,replace it.On medial side of the original rod,a new satellite rod was placed and linked with the original implants by connecting instrumentations,associated with one more segment fixed beyond the primary fixation at least.At last bone grafts were implanted and the incision was closed.[Results]All the patients had revision surgery performed smoothly without serious complications.At the latest follow up the VAS and ODI scores significantly decreased compared with those before revision surgery.The local sagittal Cobb’s angle improved from(9.89±3.19)°preoperatively to(-1.68±5.82)°at the latest follow up.[Conclusion]It is safe,simple and effective that multi-rod constructs are used for revision of rod breaking secondary to primary internal fixation of thoracolumbar fractures.