【作者】 王中吉； 夏云峰； 庄宏达； 刘学来； 于荣禄； 魏立军； 韩兴龙； 王雪冰； 徐海成； 张金禄； 张海； 关志文； 张文武； 彭喜林； 董亚军；

【Author】 Zhongji Wang;Yunfeng Xia;Hongda zhuang;Xuelai Liu;Ronglu Yu;Lijun Wei;Xinglong Han;Xuebing Wang;Haicheng Xu;Jinlu Zhang;Hai Zhang;Zhiwen Guan;Wenwu Zhang;Xilin Peng;Yajun Dong;Jilin Province Tuberculosis Hospital;

【机构】 吉林省结核病医院；

【摘要】 目的探讨后路椎弓根钉棒系统治疗胸腰椎结核出现并发症的原因及应对策略。方法将2004年1月—2017年12月同一组医师14年中采用后路椎弓根钉棒系统内固定治疗的胸腰椎结核分为前7年及后7年两组,分别为1508例。随访观察术中定位,椎弓根螺钉穿出椎弓根,螺钉脱出、松动、断裂,连接棒脱棒、断棒,顶丝脱落,术后切口感染,术后Cobb角丢失,钉棒固定之椎体再次破坏并发症的发生情况。结果治疗胸腰椎结核3016例,出现并发症187例(6.20%)。2004年1月—2010年12月前7年1508例中出现并发症124例(8.22%),其中术中定位错误6例(0.40%);椎弓根螺钉穿出椎弓根24例(1.60%),再次手术调整螺钉20例(1.33%),恢复19例,胸椎1例出现截瘫未恢复,1例胸椎螺钉偏外并较长,术后一年切口渗血,于外院取钉棒时血管大出血死亡;螺钉脱出11例(0.73%)、松动22例(1.46%)、断裂12例(0.80%),连接棒脱棒3例(0.20%)、断棒3例(0.20%),顶丝部分脱落7例(0.46%);术后切口感染24例(1.60%),经保守治疗后愈合;术后Cobb角丢失大于7度10例(0.66%);钉棒固定之椎体再次破坏2例(0.13%),经保守治愈。2011年1月—2017年12月后7年1508例中出现并发症63例(4.18%),其中术中定位错误2例(0.13%);椎弓根螺钉穿出椎弓根14例(0.93%),再次手术调整螺钉11例(0.73%),全部恢复;螺钉脱出6例(0.40%)、松动12例(0.80%)、断裂3例(0.20%),连接棒脱棒0例、断棒1例(0.07%),顶丝脱落1例(0.07%);术后切口感染16例(1.06%),1例切口未愈合,取出钉棒后愈合;术后Cobb角丢失大于7度5例(0.33%);钉棒固定之椎体再次破坏3例(0.20%),2例再次手术治愈,1例经保守治愈。后7年手术并发症少于前7年手术并发症。结论随着后路钉棒手术技术的不断提高,并发症逐渐减少。术前认真阅片,术中按技术要点谨慎操作,术后仔细观察,早期发现可预防后路钉棒技术的并发症。更多还原

【Abstract】 Objectives To explore the complications and coping strategies of posterior pedicle screw system in the treatment of thoracolumbar tuberculosis.Methods From January 2004 to December 2017,the patients with thoracolumbar tuberculosis treated by posterior pedicle screw-rod system were divided into two groups:1508 cases in the first 7 years and 7 years after the treatment.Follow-up observation showed that pedicle screw pierced through pedicle,screw prolapse,loosened,broken,loosening,breaking,disroding of connectors,breaking of rod,exfoliation of parietal filament,infection of incision after operation,loss of Cobb angle after operation,occurrence of complications of destructing vertebral body with screw and rod fixation.Results 3016 cases of thoracolumbar tuberculosis,187 cases(6.2%) had complications.Complications occurred of 124 cases(8.22%) out of 1508 cases in the first 7 years from January 2004 to December 2010,of which 6 cases(0.40%) were mislocated during the operation.The pedicle screws penetrated through the pedicle in 24 cases(1.60%),reoperated in 20 cases(1.33%),recovered in 19 cases,the thoracic vertebrae did not recover in 1 case,the thoracic screws were lateral and long in 1 case,and the incision was bleeding one year after operation.The blood vessel hemorrhage died when the nail rod was taken out of the hospital.Screw prolapse in 11 cases(0.73%),loose 22 cases(1.46%),12 cases(0.80%),3 cases(0.20%),3 cases(0.20%),7 cases(0.46%),7 cases(0.46%) and 7 cases(0.46%) respectively.Postoperative incisional infection in 24 cases(1.60%) healed after conservative treatment 10 cases(0.66%) lost Cobb angle more than 7 degrees after operation.After 7 years from January 2011 to December2017,63 cases(4.18%) had complications,of which 2 cases had mispositioning(0.1%) during the period from January 2011 to December 2017,and were cured conservatively in 2 cases(0.13%) of the vertebral bodies fixed by nailing rod fixation,and the complications occurred in 63 cases(4.18%).14 cases(0.93%) got through the pedicle screw,11 cases(0.73%) underwent reoperation adjustment screw,and all recovered.Screw prolapse was found in 6 cases(0.40%),loosening in 12 cases(0.80%),fracture in 3 cases(0.20%),disconnection rod in 0 cases,broken rod in 1 case(0.07%) and top filament in 1 case(0.07%).Postoperative incision infection was found in 16 cases(1.06%),1 incision was not healed,and 5 cases(0.33%) had Cobb angle loss more than 7 degrees after operation,and 3 cases(0.20%) had re-destruction of the vertebral body fixed with nail rod,2.One case was cured conservatively.The operative complications in the 7 years after operation were less than those in the previous 7 years.Conclusions With the continuous improvement of the technique of posterior screw-rod operation,complications are gradually reduced.The complications of posterior screw technique can be prevented early by careful reading of films before operation,careful operation according to technical points during operation and careful observation after operation.更多还原