胸腰段骨折后路手术失败原因分析及翻修策略

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Abstract Objective To explore the failure reason and revision strategy of posterior internal fixation surgery alone for thoracolumbar fracture.Methods From March 2008 to December 2014，12 thoracolumbar fracture(T₁₁～L₂)patients have had revision surgery in Spine Surgery Department of our hospital.Among them，28 was transferred from primary hospital.Reasons for revision surgery were fracture of internal fixation including pedicle screw and connecting rods combined with kyphosis.We analyzed the imaging data of primary operation and classifying it by AO classification system for thoracolumbar injuries.According to AO classification，the fractures were A3 in 4 cases，B1 in 2 cases，B2 in 5 cases，B3 in 7 cases，C in 13 cases.All patients underwent posterior internal fixation alone.The reasons of revision were misplacement of posterior pedicle screw in 3 cases，incompletely posterior decompression in 1case，the scoliosis after removal of the internal fixation in 1 case and unimproved symptoms after primary surgery in 2 cases.Neurological deficits were progressively aggravated after fracture of the internal fixation in 26 cases.All these patients had back pain.The anterior vertebral resection，reconstruction and fusion by Iliac bone or titanium mesh，posterior internal fixation for long segment and decompression of vertebral canal with corresponding segments，posterior transpedicular wedge osteotomy were performed according to the actual situation.Results According to AO classification system，revision rates were 12.9% in type A，45.16% in type B and 41.93% in type C.No case of internal fixation failure had been found again during 12～24 months follow-up，and all patients had obtained bony fusion after 10～12 months follow-up.Frankel classification improved 0～2(1.3±0.79)level，Visual analog scale(VAS)decreased from 6.9 preoperationally to 2.4 during last follow-up，oswestry disability index(ODI)decreased from 46.3 to 12.4.Kyphosis angle improved in 26 patients from 10°～58°(40.5±15.3)° preoperationally to －3～7°(2.3±3.7)° postoperationally which only losses 0°～1.3°(0.6±0.2)during last follow-up，and the final correction rate was 91.8%.Conclusion Main reason for the failure of thoracolumbar fracture posterior surgery is that primary hospital did not pay enough attention to fracture classification before surgery.For type B and type C patient posterior internal fixation alone often leads to failure.Revision surgery to reconstruct anterior and middle column of fracture is the key to prevent the internal fixation from failing again，by the side，it had definite curative effect on the pain and deformity caused by the failure of the primary operation.

Key words： thoracolumbar injuries spinal fracture failure of posterior internal fixation revision surgery

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