高位骶骨肿瘤切除内固定术后内置物断裂原因分析

Hardware failure of lumbosacral reconstruction after sacral tumor resection, causes analysis

中文关键词:  骨肿瘤  骶骨肿瘤  腰骶部重建  内固定断裂  翻修手术

英文关键词:Orthopaedic oncology  Sacral tumor  Lumbosacral reconstruction  Breakage  Revision surgery

中文摘要:

  【摘要】 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。

英文摘要:

  【Abstract】 Objectives: To investigate the causes of failed lumbosacral reconstruction after sacral tumor resection and its intervention. Methods: 12 patients diagnosed with high sacrum tumor and complicated with hardware failure following tumor resection and lumbosacral reconstruction during January 2007 and Octorber 2013 were reviewed retrospectively. All 12 patients received revisional surgical intervention. There were 4 males and 8 females with an average age of 30.4 years(18~62 years). The data related to failure were recorded, which included sacral defect, location of breakage, the diameter of rod, the union of bony graft and BMI of patients. Results: There were 7 cases of S1-S5 involvement and S2-S5 involvement in 5 cases. The lumbar pedicle screws were inserted in L2 and L3 in 1 case, L3 and L4 in 4, L4 and L5 in seven cases. The breakage occurred at an average age of 17.1 months(range, 8-24 months) after primary surgery. The most common cause for the failure was the breakage of rod, which occurred in 10 patients with 2 bilateral sides and 8 unilateral. Iliac screw breakage and loosening were observed in 2 and 4 cases respectively. The 5.5mm-diameter rod was used in 4 cases, 2 of them were noted bilateral breakage. Non-union of allograft was observed in 6 patients, 3 of them received radiation therapy after reconstruction. 5 out of 12 patients had BMI above 25. The implant was removed in 5 patients. Revision and bone graft were performed in 7 patients. Free fibular graft was used in 2 patients. 2 patients were noted breakage again at 12 and 21 months respectively and all received revisional surgery. No further breakage was observed in these 2 patients after 10 and 8 months follow-up respectively. Conclusions: The reconstruction of lumbosacral after high level sacral tumor resection still remains challenging. Rod breakage is most common for hardware failure. The possible reasons are non-union of allo/autograft, compared small diameter of connection rod, Improper level of pedicle screw insertion and patients′ high BMI, all these can be treated by revisional surgery.