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首页> 外文期刊>Spine >Potential large vessel injury during thoracolumbar pedicle screw removal. A case report.
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Potential large vessel injury during thoracolumbar pedicle screw removal. A case report.

机译：胸腰椎椎弓根螺钉拆除过程中潜在的大血管损伤。病例报告。

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摘要

STUDY DESIGN: A case study of a previously unreported complication of unsuccessful broken pedicle screw removal in the thoracolumbar spine is presented. OBJECTIVES: To emphasize an increased awareness of the potential for large vessel injury during difficult broken pedicle screw removal in the thoracolumbar spine and to encourage the thorough evaluation of indications for the removal of any broken distal fragment in a vertebral body. SUMMARY OF BACKGROUND DATA: Reported complications of pedicle screw removal include the inability to remove the distal screw fragment, nerve root injury, and dural sheath violation. Damage to anterior vascular structures, including the vena cava, iliac arterial and venous systems, and aorta, has not yet been reported in association with difficult broken pedicle screw removal. METHODS: An instrument designed to capture the distal end of a screw fragment through an interference fit resulted in inadvertent screw migration into the retroperitoneal space. Plain roentgenograms and computed tomography were used to document this complication, revealing the close proximity of the screw fragment to the aorta. RESULTS: Expedient recognition of the anteriorly migrated screw fragment with its subsequent removal resulted in a satisfactory outcome. CONCLUSION: Great care must be taken during the removal of broken pedicle screws to prevent injury to surrounding structures. Additionally, indications for the removal of distal screw fragments must be carefully established. Instruments designed to capture the end of the distal screw fragment through an interference fit may allow anterior screw migration to occur, particularly in osteoporotic bone.
机译：研究设计：一项病例研究报告了先前未报告的胸腰椎椎弓根螺钉断裂失败的并发症。目的：强调人们越来越多地意识到在胸腰椎脊柱椎弓根螺钉难以拆除的过程中可能造成大血管损伤的可能性，并鼓励彻底评估各种指征以去除椎体中任何远端破碎的指征。背景数据摘要：报道的椎弓根螺钉切除术并发症包括无法切除远端螺钉片段，神经根损伤和硬脑膜鞘侵犯。尚未见到与困难的椎弓根螺钉拆除有关的前血管结构损伤，包括腔静脉，动脉和静脉系统以及主动脉。方法：一种旨在通过过盈配合来捕获螺钉碎片远端的器械，导致螺钉无意间迁移到腹膜后腔。使用普通的X线断层扫描和计算机断层扫描来记录这种并发症，显示出螺钉碎片与主动脉的紧密距离。结果：方便地识别前移的螺钉碎片并随后将其去除，结果令人满意。结论：在拆除破裂的椎弓根螺钉时必须格外小心，以防止对周围结构造成伤害。此外，必须仔细确定移除远端螺钉碎片的指示。设计用于通过过盈配合来捕获远端螺钉片段末端的器械可能允许发生前螺钉迁移，特别是在骨质疏松性骨中。

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