Posterior segmental instrumentation for thoracolumbar hemivertebra:the case of loosening of instrumentation and reversion
- VernacularTitle:胸腰椎半椎体畸形后路矫形节段内固定松动失效原因分析及翻修术
- Author:
Bo LI
;
Minghua ZHANG
;
Hua ZHENG
- Publication Type:Journal Article
- Keywords:
thoracic vertebrae;
lumbar vertebrae;
congenital scoliosis;
hemivertebra;
internal fixators;
reversion
- From:
Orthopedic Journal of China
2006;0(21):-
- CountryChina
- Language:Chinese
-
Abstract:
[Objective]To evaluate the factors causing loosening of instrumentation and the progressive deformities after treating thoracolumbar bemivertebra with segmental instrumentation,and analyze the outcomes and strategies of reversion.[Method]A retrospective study was made in 7 cases with loosening of instrumentation and the progressive deformities secondary to operation on thoracolumbar hemivertebra in our hospital.There were 3 males and 4 females,with age range of 1.8~13 years.Preoperative mean Cobb's angles of scoliosis was 34.1?,and kyphosis was 40.2?.All cases were treated with posterior reversion.[Result]The failure factors of primary surgery were resulted from:failure of single hemivertebra resection(4 cases),shortage of segments fixation and bone graft(5 cases),unsatisfactory selection of instrumentation(2 cases),failure of manipulation in young children(2 cases),segment fixation without fusion(1 case).Postoperative mean Cobb's angle of scoliosis was 12.6?,with correction rate of 63.0%,and kyphosis was 17.3?,with correction rate of 56.9%.The revision cases were followed up for 18 to 28 months and showed that all patients got satisfactory cosmetic correction and fine fusion.No neurological complication or infection occurred,no implant failure were verified at the final radiographic evaluation.[Conclusion]The reasons for postoperative loosening of instrumentation and the progressive deformities includs:free from hemivertebrectomy,inappropriate segments fixation and bone graft,unsatisfactory selection of instrumentation,impropermanipulation in young children,fixation without fusion.If the above-mentioned five reasons of reversion strategies have been considered and avoided,the clinical results will be satisfactory.
