摘要目的 探讨胸腰椎角状后凸后路矫形内固定失败的发生原因及治疗方法.方法 对2005年6月至2011年12月北京大学第三医院骨科手术治疗后出现内固定失败的8例胸腰椎角状后凸患者进行回顾性研究.手术方式包括后路闭合截骨矫形(PSO)、后路前方撑开-后方闭合截骨矫形(AOPC)、后路后凸节段切除-双轴旋转矫形(VCR).对内固定失败的原因进行分析,并进行翻修手术治疗.结果 内固定失败的发生率为6.3％.发生时间平均为术后22.5个月,其中1例患者为术后3个月,其他患者均为术后1年以上.8例患者中,5例为陈旧结核,2例为陈旧创伤,1例为先天性后凸畸形.手术方式:7例患者为VCR手术,1例患者为AOPC矫形.8例患者内固定失败后均出现腰背痛症状,其中3例患者合并下肢神经症状复发.内固定失败的原因或危险因素包括植骨不融合、VCR手术、钛网下沉、锚定点数量不足,后凸角度较大等.8例患者均行翻修手术并恢复良好.结论 胸腰椎角状后凸后路矫形内固定失败相对迟发,可由多种原因造成.积极的翻修手术对内固定失败具有良好效果.

abstractsObjective To analyze the etiology of instrumentation failure after corrective surgery for thoracolumbar focal kyphosis,and make suggestion for treatment.Methods Retrospective study for 8 patients with thoracolumbar focal kyphosis who underwent surgical treatment and suffered instrumentation failure from June 2005 to December 2011 was made.The surgical procedures included pedicle subtraction osteotomy (PSO),anterior opening-posterior closing osteotomy and correction (AOPC),and posterior vertebral column resection (VCR).The reasons of instrumentation failure were analyzed and revision surgeries were performed.Results The incidence of instrumentation failure was 6.3％.The average occurrence time was 22.5 months after surgery.Except one had failure in 3 months after surgery,all cases happened after 1 year.In this series,there were 5 cases with post-tuberculosis,2 cases with post-traumatic kyphosis and 1 case with congenital kyphosis.For the surgical procedure,7 cases underwent VCR and 1 case AOPC.After the instrumentation failure,all cases had back pain,and 3 of them had combined neurological symptoms.The reasons or risk factors of instrumentation failure included non-fusion of bone graft,VCR procedure,sink of the titanium mesh,insufficiency of anchor sites,and more severe kyphosis.All the 8 cases were treated with revision surgery and got good results.Conclusions The instrumentation failure of thoracolumbar focal kyphosis is relatively late occurred,and can develop with various reasons.Positive revision surgery is suggested for the instrumentation failure,and good results can be expected.