科研之友
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摘要
Dislocation and screw pull-out after the application of an Isobar TTL are rarely reported in previous studies. A 48-year-old male patient was diagnosed with L4-L5 tuberculosis and received posterior debridement surgery with instrumentation; however, 15 months after his first surgery the patient suffered from severe intervertebral disc herniation at L2/3. At this time the patient underwent his second surgery: the nucleus pulposus of L2/3 was removed and the Isobar TTL system was applied at L2/3. Six months after his second surgery the patient strained his back and, returned to our hospital. The lumbar X-rays showed the dislocation of L2/3 and screw pull-outs in the Isobar TTL implant. Then the patient received his third surgery: the Isobar TTL was removed, the spinous process and lamina of L3 along with the intervertebral disc at L2/3 were resected, porous nano-hydroxyapatite/polyamide 66 (n-HA/PA66) composite was inserted at L2/3, cement reinforced pedicle screws were used, and autogenous bone combined with artificial bone was implanted on the surface of the lamina from L2 to S1 for fusion. In conclusion, selection of an appropriate patient is important when using the Isobar TTL system. The lamina should not be resected too much, the facet joints should not be violated, and pedicle screw adjustment should also be avoided in its application. The angle between the screw and rod should be appropriate so that it avoids strength concentration on the pedicles and screws which may lead to instrumental complications. The real causes remain unclear at present, and therefore future biomechanical and clinical studies are needed.
- 出版日期2018
- 单位四川大学
