胸腰椎半椎体畸形后路矫形节段内固定松动失效原因分析及翻修术.doc

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1、胸腰椎半椎体畸形后路矫形节段内固定松动失效原因分析及翻修术【摘要】探讨胸、腰椎半椎体畸形后路矫形节段内固定的松动、失效原因，并分析翻修术的疗效及策略。［方法］回顾性分析本院收治的胸、腰椎半椎体畸形后路矫形节段内固定的松动、失效患者7例，其中男3例，女4例；年龄1.8～13岁。就诊时术前侧弯Cobbs角平均34.1°，后凸平均为40.2°。均行后路翻修术。［结果］初次手术未切除孤立单发的半椎体4例，固定及融合节段过短5例，术中对幼儿矫形操作不当2例，内固定选择不佳2例，术中未植骨融合1例。本组术后侧弯Cobbs角平均12.6°，矫形率63.0%。后凸Cobbs角术后17.3°，矫形率56

2、.9％，随访18~28个月，获得矫形无丢失，植骨融合良好。无感染、脊髓神经损伤、内固定失败。［结论］未切除孤立单发的半椎体、固定及融合节段的策略失误、术中对幼儿矫形操作不当、内固定选择不佳、术中未植骨融合的影响是初次术后内固定的松动、失效原因。在翻修术中避免以上5种原因而制订策略，临床疗效满意。【关键词】胸椎腰椎先天性脊柱侧凸半椎体内固定器翻修术Abstract：［Objective］Toevaluatethefactorscausinglooseningofinstrumentationandtheprogressivedeformitiesaftertreatingthoracolumb

3、arbemivertebrawithsegmentalinstrumentation,andanalyzetheoutcomesandstrategiesofreversion.［Method］Aretrospectivestudywasmadein7caseswithlooseningofinstrumentationandtheprogressivedeformitiessecondarytooperationonthoracolumbarhemivertebrainourhospital.Therewere3malesand4females,withagerangeof1.8~13ye

4、ars.PreoperativemeanCobbsanglesofscoliosiswas34.1°,andkyphosiswas40.2°.Allcasesweretreatedwithposteriorreversion.［Result］Thefailurefactorsofprimarysurgerywereresultedfrom:failureofsinglehemivertebraresection（4cases）,shortageofsegmentsfixationandbonegraft（5cases）,unsatisfactoryselectionofinstrument

5、ation（2cases）,failureofmanipulationinyoungchildren（2cases）,segmentfixationwithoutfusion（1case）.PostoperativemeanCobbsangleofscoliosiswas12.6°,withcorrectionrateof63.0%,andkyphosiswas17.3°,withcorrectionrateof56.9%.Therevisioncaseswerefollowedupfor18to28monthsandshowedthatallpatientsgotsatisfactory

6、cosmeticcorrectionandfinefusion.Noneurologicalcomplicationorinfectionoccurred,noimplantfailurewereverifiedatthefinalradiographicevaluation.［Conclusion］Thereasonsforpostoperativelooseningofinstrumentationandtheprogressivedeformitiesincluds:freefromhemivertebrectomy,inappropriatesegmentsfixationandbo

7、negraft,unsatisfactoryselectionofinstrumentation,impropermanipulationinyoungchildren,fixation5withoutfusion.Iftheabovementionedfivereasonsofreversionstrategieshavebeenconsideredandavoided,theclinicalresult