椎体间螺纹融合器行腰椎融合术并发症

目的总结椎体间螺纹融合器行腰椎融合术的并发症,分析原因,探索其防治策略.方法自1997年7月～2004年11月,椎体间螺纹融合器行腰椎融合术共96例,单纯峡部裂15例,峡部裂性滑脱78例,退变性滑脱3例,Ⅰ度62例,Ⅱ度19例.前入路75例,后入路21例,置入融合器124枚.结果96例术后随访6～88个月,围手术期并发症：神经根牵拉伤4例,马尾神经损伤2例,硬脊膜撕裂3例,硬膜外血肿1例,髂静脉撕裂4例,下肢静脉血栓1例,髂骨供区疼痛7例,合并臀部皮肤麻木2例.术后中远期并发症：持续性下肢神经症状2例,融合器移位2例、沉陷入椎体8例.结论椎体间螺纹融合器行腰椎融合术是一种新的脊柱融合方法,具有较好的临床效果,但并发症较多,必须提高手术技术,严格掌握手术适应证,规范手术操作,积极预防和及时处理并发症.

Complications of lumbar interbody fusion with threaded fusion cages

Objective To study the causes and prevention of the complications of lumbar interbody fusion with threaded fusion cages. Methods The 96 patients who had undergone lumbar interbody fusion with threaded fusion cages from July 1997 to November 2004, were reviewed. There were 15 cases of spondylolysis, 78 isthmic spondylolisthesis and 3 degenerative spondylolisthesis. 62 cases in the series were of grade I and 19 cases were of grade n , according to Meyerding classification. 75 operations were performed by anterior approach, the other 21 by posterior approach, and a total of 124 cages were implanted. Resuits The patients were followed up for 6 - 88 months. The complications in peri - operative period included 4 caases of nerve root damage, 2 eauda equina injury, 3 dural laceration, 1 spinal epidural hematoma, 4 lilac vein tear, 1 phlebothrombosis of leg, 7 pain of iliac donor site and 2 complicated superior gluteal nerve damage. Thelate complications included 2 cases of persistent neuropathy, 2 cage displacement and 8 cage subsidence. Conclusion The lumbar interbody fusion with threaded fusion cage, as a new technique, is accompanied by severe and multiple complications, which can only be minimized by improving the surgical skill, right selection of patients, proper manipulation, early diagnosis and prompt management.