颈椎骨折脱位患者术后内固定物松动的危险因素探讨及建议  

Discussion and suggestion of risk factors for postoperative internal fixation loosening in patients with cervical spine fracture and dislocation

作　　者：李强[1] 王家宝 周丙玲 孙明辉 王永胜 段方方 LI Qiang;WANG Jia-bao;ZHOU Bing-ling;SUN Ming-hui;WANG Yong-sheng;DUAN Fang-fang(the First People’s Hospital of Suzhou,Suzhou,Anhui,234000,China)

机构地区：[1]宿州市第一人民医院,安徽宿州234000

出　　处：《颈腰痛杂志》2020年第3期281-285,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：宁夏回族自治区自然科学基金(编号:NZ16212)。

摘　　要：目的探讨颈椎骨折脱位患者术后内固定物松动的危险因素及预防建议。方法回顾276例颈椎骨折脱位内固定术后患者的资料,总结可能导致内固定术后松动的危险因素,对比松动者和未松动者可能影响因素的构成比,并进行Logistic回归分析。结果术后共有23例患者内固定物松动,分别发生于术后2~3个月5例,6~8个月13例,9~10个月4例,15~16个月1例,松动率为8.33%。松动组高能量损伤、合并脊髓损伤、粉碎性骨折、钢板长度不合适、螺钉长度不合适、支具保护时间≤3个月、未采用康复指导、术后呼吸道感染的构成比均明显高于未松动组(P<0.05);经Logistic回归分析可知,高能量损伤、合并脊髓损伤、粉碎性骨折、钢板长度不合适、螺钉长度不合适、支具保护时间≤3个月、未采用康复指导、术后呼吸道感染,均是影响颈椎骨折脱位患者术后内固定物松动的独立危险因素(OR=5.523、5.171、5.479、5.073、5.534、5.675、5.403、7.523,P<0.05)。结论高能量损伤、合并脊髓损伤、粉碎性骨折、钢板长度不合适、螺钉长度不合适、支具保护时间≤3个月、未采用康复指导、术后呼吸道感染,均是颈椎骨折脱位患者术后内固定物松动的独立危险因素,需加强防控。Objective To explore the risk factors and prevention suggestions for postoperative internal fixation loosening in patients with cervical spine fracture and dislocation.Methods The clinical data of 276 patients with cervical fracture and dislocation after internal fixation were retrospectively reviewed.The risk factors that may lead to loosening after internal fixation were summarized.The composition ratio of influential factors between loose and unsweetened were compared,then Logistic regression analysis was used.Results A total of 23 patients had loose internal fixation after operation,5 cases were loosened in 2-3 months after operation,13 cases were loosened 6-8 months after operation,4 cases were loosened 9-10 months after operation,and 1 case was loosened after 15-16 months,the looseness rate was 8.33%.The composition ratios of high-energy injury,combined spinal cord injury,comminuted fracture,unsuitable length of the plate,improper screw length,brace protection time≤3 months,no rehabilitation guidance,postoperative respiratory infection in loosened group were significantly higher than those in the unsweetened group(P<0.05).Logistic regression analysis showed that high energy injury,combined spinal cord injury,comminuted fracture,improper length of steel plate,improper screw length,brace protection time≤3 months,no rehabilitation guidance,postoperative respiratory infection were independent risk factors for postoperative internal fixation loosening in patients with cervical spine fracture and dislocation(OR=5.523,5.171,5.479,5.073,5.534,5.675,5.403,7.523,P<0.05).Conclusions The independent risk factors for postoperative internal fixation loosening in patients with cervical spine fracture and dislocation include high-energy injury,combined spinal cord injury,comminuted fracture,improper length of the plate,inappropriate screw length,brace protection time≤3 months,no rehabilitation guidance,postoperative respiratory infection,which need to be strengthened prevention and control.

关 键 词：颈椎骨折脱位 内固定物松动 危险因素 建议 

分 类 号：R687.3[医药卫生—骨科学]