中国矫形外科杂志2002年11月第10卷第13期OrthopJChin,Vol.10,No.13November2002·7721··论著·脊柱内固定翻修的原因和对策叶晓健沈康平贾连顺侯黎升樊健君王长峰摘要目的:回顾性分析脊柱内固定翻修手术的原因,寻求避免内固定失败或失效的对策。方法:本组31例患者,男20例,女11例,年龄22～58岁,颈椎病前路带锁钢板内固定术后钢板螺钉位置不佳、松动脱出4例,颈椎前路Cage松动或脱出1例,胸腰骶椎骨折内固定椎弓根螺钉位置不佳9例,松动或脱出3例,螺钉断裂3例,胸腰椎前路钢板松动2例,术后矫形丧失出现后凸畸形5例,腰椎BAK脱出2例。内植物选择不当2例。临床症状有畸形、局部疼痛、肢体疼痛麻木等。结果:内固定选择不当或螺钉位置不佳等引起内固定失败和/或失效的为22例,占70.9%;内植物断裂4例,占12.9%,患者过早负重或外伤引起的5例,占16.1%。共18例更换内植物,其它13例调整内植物位置。术后随访6个月～3年8个月,平均2年3个月。翻修术后19例患者局部症状及肢体疼痛麻木等症状消失,X线片上显示内植物位置良好,原有畸形消失;2例吞咽困难获得改善,其它患者无不适主诉。结论:技术性原因是造成翻修手术的首要原因,其次是应力遮挡。应加强脊柱外科领域的专业培训。关键词脊柱;内固定;翻修术中图分类号R681.5文献标识码A文章编号1005-8478(2002)13-1277-03RevisionofInternalSpinalInstrumentation:CausesandPrevention∥YEXiao2jian,SHENKang2ping,JIALian2shun,etal.DepartmentofOrthopaedics,ChangzhengHospital,theSecondMilitaryMedicalUniversity,415FengyangRoad,Shanghai,200003AbstractObjective:AretrospectiveanalysiswascarriedouttodeterminethefactorscontributingtotherevisionofinternalspinalinstrumentationtreatedatChangzhengHospitaltoexplorerelevantpreventionmeasures.Methods:31cases(20male,11female,ageranged22～58years)requiredrevisionprocedure.Of31cases,4casesdevelopedscrewpulloutofanteriorcervicallockingscrew2platedevice,1loosingofcervicalcage.While9experiencedpoororientation,3loosingand3brokenofpediclescrewofposteriorthoracicorlumbarorsacralpediclescrewplatedeviceand2loosingofanteriorthoracolumbarplatesystem.5kyphosisdeformityfollowingsurgicalcorrection,2dropoutoflumbarBAKand2improperimplants.These31casesshowedde2formity,localpain,legorarmpainandnumbness.Results:Improperimplants.wrongorientationorloosingofimplantsledto22failures(70.9%),stressshieldingorpoorqualityofimplantdevicewasresponsiblefor4brokenimplants(12.9%),5cases(16.1%)wererelatedtoearlyloadingorextratrauma.Oftotalrevision,18caseswerechangedimplant,13adjustedlocationandori2entationofimplant.Withmeanfollow2upof27months(ranged6～44months).NinteencasesclaimedoftotaldisappearanceoflocalorarmorlegpainwithX2raydemonstratinggoodimplantpos