摘要
目的总结经皮微创复位内固定术治疗胸腰椎骨折术中及术后并发症发生情况,并分析其原因。方法 2012年2月—2015年2月,采用后路经皮微创椎弓根螺钉内固定术治疗且随访资料完整的胸腰椎骨折患者742例,其中男425例,女317例;年龄17～60(41.9±8.6)岁;损伤节段:T11 82例,T12 227例,L1 231例,L2 93例,L3 69例,L4 40例。AO分型:A1型262例、A2型95例、A3型335例、B1型41例,B2型9例。详实统计并分析术中、术后并发症的发生情况及其原因。结果所有患者随访11～36(22.9±5.8)个月。共46例发生并发症(6.2%),其中术中并发症7例,包括导丝断裂3例,腹主动脉损伤1例,硬膜损伤3例;术后并发症39例,包括螺钉位置不良17例(共19枚钉),螺钉断裂8例,螺塞脱落2例,连接棒松动3例,复位不良4例,迟发性感染5例。7例术中并发症患者经术中及时处理,手术顺利完成;39例术后并发症患者中14例行手术翻修,其余患者给予支具等辅助治疗,术后恢复良好。结论经皮微创复位内固定术治疗胸腰椎骨折术中及术后并发症包括感染、血管损伤、螺钉位置不良、复位欠佳、内固定失败等,其中最常见的并发症为螺钉位置不良,其发生率为2.29%(17/742);并发症发生主要原因为手术误操作,占52.2%(24/46)。
Objective To summarize the complications of percutaneous minimally invasive reduction and internal fixation in the treatment of thoracolumbar fractures and discuss the underlying causes of these complications.Methods From February2012to February2015,742patients with thoracolumbar fractures were treated with posterior percutaneous minimally invasive pedicle screw fixation.There were425males and317females with the age of17-60(41.9±8.6)years old.The involved segments included T11in82cases,T12in227,L1in231,L2in93,L3in69and L4in40.According to AO classification,A1type was seen in262cases,A2type in95,A3type in335,B1type in41and B2type in9.The occurrence and causes of intraoperative and postoperative complications were analyzed statistically.Results All the patients were followed up for11-36(22.9±5.8)months.There were46patients presenting with complications(5.9%),including intraoperative complications in7and postoperative complications in39.Intraoperative complications included3of guide wire feature,1of abdominal artery injury and3of dural injury.Postoperative complications included pedicle screw misplacement in17cases(19screws in total),screw breakage in8,nut falling off in2,connecting rod loosening in3,poor reduction in4and flate infection in5.Seven cases with intraoperative complications were treated in time,and the operations were completed successfully.Of the39patients with postoperative complications,14underwent surgical revision,and the remaining received braces and other adjuvant treatments,and the postoperative recovery was good.Conclusion Percutaneous minimally invasive reduction and internal fixation for treating thoracolumbar fractures has many intraoperative and postoperative complications,such as infection,injury to blood vessels,pedicle screw misplacement,malreduction and internal fixation failure.Pedicle screw misplacement is the most common complication with an incidence rate of2.29%(17/742),and its main cause is misoperation during the surgery with an incidence of52.2%(24/46).
作者
张海平
郝定均
贺宝荣
赵勤鹏
郭华
王晓东
刘团江
何思敏
ZHANG Hai-ping;HAO Ding-jun;HE Bao-rong;ZHAO Qin-peng;GUO Hua;WANG Xiao-dong;LIU Tuan-jiang;HE Si-min(Department of Spinal Surgery,Honghui Hospital,Xi’an JiaoTong University Medical College,Xi’an 710054,Shaanxi,China)
出处
《脊柱外科杂志》
2018年第6期344-348,共5页
Journal of Spinal Surgery
基金
国家自然科学基金(81472098)
关键词
胸椎
腰椎
脊柱骨折
外科手术
微创性
手术中并发症
手术后并发症
Thoracic vertebrae
Lumbar vertebrae
Spinal fractures
Surgical procedures,minimally invasive
Intraoperative complications
Postoperative complications
作者简介
张海平(1981-),博士在读,主治医师;zhp502@163.com;通信作者:郝定均,haodingjundr@163.com.
