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目的:探讨高位骶骨肿瘤切除腰骶内固定术后内置物断裂原因及其处理方法。方法 :2007年1月~2013年10月共12例高位骶骨肿瘤切除腰骶内固定术后内置物断裂病例,均接受翻修手术治疗。其中男4例,女8例,年龄33.4±15.6岁(18~62岁)。记录与内固定断裂可能相关数据:肿瘤累及范围,内置物断裂部位,金属连接棒直径,植骨愈合情况,固定节段及患者体重指数(BMI)。结果:肿瘤累及S1~S5 7例,S2~S5 5例。腰椎椎弓根螺钉置于L2、L3节段1例,L3、L4节段4例,L4、L5节段7例。内置物断裂出现在术后17.1±4.7个月(8~24个月)。金属连接棒断裂10例,其中单侧金属连接棒断裂8例,双侧金属连接棒断裂2例;髂骨固定螺钉断裂2例。髂骨螺钉松动4例。4例患者采用直径5.5mm金属连接棒,其中2例为双侧金属连接棒断裂。6例患者出现植骨未愈合,其中3例患者术后接受放疗治疗。BMI>25的患者共5例。翻修手术:5例患者仅行内固定取出;7例患者行内固定取出,再次固定+植骨,其中2例行自体腓骨移植重建。2例患者分别在初次翻修后12个月和21个月再次出现单侧金属连接棒的断裂,均再次接受翻修手术,二次翻修手术后分别随访10个月和8个月未再出现断裂。结论:高位骶骨肿瘤切除内固定术后,内置物断裂中最常见为一侧金属连接棒的断裂;内固定失败可能与金属连接棒过细、植骨不愈合、患者体重指数过大及固定节段不合理有关;通过合理的翻修手术可较好地解决内固定断裂问题。
OBJECTIVE: To investigate the causes and treatment of rupture of internal fixation after high sacral tumor resection for lumbosacral internal fixation. Methods: From January 2007 to October 2013, a total of 12 patients with ruptured internal fixation of lumbosacral internal fixation underwent sacral tumor resection were treated with revision surgery. Including 4 males and 8 females, aged 33.4 ± 15.6 years (18 to 62 years old). Recordable data related to internal fixation fracture: extent of tumor involvement, site of rupture of the implant, diameter of the metal connecting rod, healing of the bone graft, fixation segment, and patient’s body mass index (BMI). Results: The tumor involved S1 ~ S5 in 7 cases, S2 ~ S5 in 5 cases. Lumbar pedicle screw placement in L2, L3 segment in 1 case, L3, L4 segment in 4 cases, L4, L5 segment in 7 cases. The rupture of the internal component occurred 17.1 ± 4.7 months after surgery (8 to 24 months). There were 10 cases of fracture of the metal connecting rod, including 8 cases of unilateral metal rod fracture, 2 cases of bilateral metal rod fracture, and 2 cases of ilium fracture. Iliac screw loose in 4 cases. Four patients had 5.5 mm diameter metal lugs, of which two were bilateral metal lugs. Six patients did not heal bone graft, of which three patients received radiotherapy after surgery. There were 5 patients with BMI> 25. Revision surgery: 5 patients underwent internal fixation only; 7 patients underwent internal fixation, and again fixed + bone graft, of which 2 patients underwent autologous fibular graft reconstruction. Two patients underwent reoperation of the unilateral metallic lysis bar at 12 months and 21 months after initial revision, respectively. All patients underwent reoperation. No reoperation occurred after 10 and 8 months of follow-up respectively. CONCLUSIONS: The most common rupture of the internal fixation is the rupture of one side of the metal connecting rod after the high sacral tumor resection and internal fixation. The internal fixation failure may be too small with the metal connecting rod, the bone graft does not heal, the patient’s body mass index is too large and the fixed segment Unreasonable; through reasonable renovation surgery can be a better solution to the problem of internal fixation fracture.