VSP stabilization of lumbar neoplasms: technical considerations and complications.
VSP stabilization of lumbar neoplasms: technical considerations and complications.
复制标题
腰椎肿瘤的 VSP 稳定：技术考虑因素和并发症。
DOI：
10.1097/00002517-199109000-00014
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
J. Weinstein
中科院分区：
文献类型：
--
作者：
R. McLain;M. Kabins;J. Weinstein
使用可变螺钉位置（VSP）钢板和椎弓根螺钉固定来稳定11例腰椎肿瘤。失血量和并发症与其他后路节段固定方法相当，尽管手术时间较长。与使用椎板下钩或钢丝的系统相比，融合节段较少，8/11例患者接受双节段固定治疗。4名术前接受过放射治疗的患者发生了43%的并发症，并发生了70%的主要并发症。18%的患者发生伤口感染，18%的患者发生血管损伤，36%的患者发生一过性神经功能缺损。两名患者出现临床假关节，两名肾癌患者肿瘤进展导致晚期不稳定。4例患者在12-18个月内因硬膜压迫和晚期塌陷导致治疗失败。4名患者发生固定失败，3名患者因螺钉上的接骨板松动，1名患者因螺钉断裂。未能充分解决前柱疾病是这些患者治疗失败的主要原因。同样，椎弓根螺钉上钢板的正确就位对于结构稳定性和寿命至关重要。VSP器械提供刚性固定，允许比传统系统更广泛的肿瘤切除，同时保留椎体运动节段。然而，未能解决关键的技术和生物力学原则可能会导致严重的并发症。
Variable screw placement (VSP) plates and pedicle screw fixation were used to stabilize eleven lumbar neoplasms. Blood loss and complications were comparable to other methods of posterior segmental fixation, although operative times were longer. Fewer levels were fused than for systems using sublaminar hooks or wires, with 8/11 patients treated with two level fixation. Four preoperatively irradiated patients experienced 43% of all complications and had 70% of the major complications. Wound infections occurred in 18%, vascular injuries in 18%, and transient neurologic deficits in 36% of our patients. Clinical pseudoarthroses developed in two patients, and tumor progression produced late instability in two patients with renal carcinoma. Thecal compression and late collapse led to therapeutic failure in four patients in 12-18 months. Fixation failure occurred in four patients, resulting from loosening of the plate on the screws in three patients, and breakage of a screw in one. Failure to adequately address anterior column disease was the primary cause of treatment failure in these patients. Proper seating of the plate on the pedicle screws is, likewise, crucial to construct stability and longevity. VSP instrumentation provides rigid fixation and allows more extensive tumor resection than traditional systems, while sparing vertebral motion segments. However, failure to address key technical and biomechanical principles may lead to serious complications.