不同终板形态对经椎间孔入路腰椎椎间融合术后融合器沉降的影响

目的　探讨不同椎体终板形态对经椎间孔入路腰椎椎间融合术(TLIF)后融合器沉降发生率的影响。方法回顾性分析2015年1月—2016年8月接受TLIF治疗的75例单节段腰椎退行性疾病患者的临床和影像学资料。根据术前矢状面MRI椎体终板形态分为规则组54例(A组)和不规则组21例(B组),比较2组患者术前、术后及末次随访时腰椎侧位X线片上测量的影像学参数(椎间隙高度、椎间孔高度、腰椎前凸角及腰椎局部前凸角),采用Oswestry功能障碍指数(ODI)评估患者腰椎功能,采用腰痛和下肢痛视觉模拟量表(VAS)评分评估患者生活质量。结果所有手术顺利完成。所有患者术后随访2.0 ～ 3.9(2.7±0.7)年。末次随访时,B组椎间隙高度及腰椎局部前凸角矫正丢失率高于A组,差异有统计学意义(P 0.05);2组椎间孔高度和腰椎前凸角矫正率无明显丢失。末次随访时,2组患者ODI及腰痛、下肢痛VAS评分较术前显著改善,B组腰痛VAS评分高于A组,差异均有统计学意义(P 0.05)。末次随访时,16例(21.3%)患者发生融合器沉降,A组7例(13.0%),B组9例(42.9%);其中重度沉降3例,A组1例,B组2例。结论终板形态不规则患者TLIF术后融合器沉降发生率显著高于终板形态规则患者,且术后易发生椎间隙高度及腰椎局部前凸角的矫正度丢失。

Effects of different endplate morphology in transforaminal lumbar interbody fusion on postoperative Cage subsidence

Objective To explore the influence of different endplate morphology in transforaminal lumbar interbody fusion(TLIF) on the incidence of postoperative Cage subsidence. Methods From January 2015 to August 2016,the clinical and imaging data of 75 patients with lumbar degenerative diseases receiving single-segment TLIF were retrospectively analyzed. According to the endplate morphology on preoperative sagittal MRI,the patients were divided into the regular group of 54 cases(group A) and irregular group of 21 cases(group B). The imaging parameters(intervertebral height,foraminal height,lumbar lordosis angle and local lumbar lordosis angle) were compared between the 2 groups at pre-operation,post-operation and the final follow-up. Oswestry disability index(ODI) was used to evaluate the lumbar function,and visual analogue scale(VAS) scores for low back and leg pain were used to evaluate the quality of life. Results All the operations were completed successfully. All the patients were followed up for 2.0-3.9(2.7±0.7)years. At the final follow-up,the correction loss of intervertebral height and local lumbar lordosis angle in group B were higher than those in group A,and the differences were statistically significant(P<0.05);and there was no significant loss of correction rate in the foraminal height and lumbar lordosis angle of the 2 groups. At the final follow-up,ODI and VAS scores for low back and leg pain in the 2 groups were improved than those at pre-operation,and the VAS score for low back pain in group B was higher than that in group A,all with statistically significant differences(P<0.05). At the final follow-up,16 patients(21.3%) were diagnosed as having Cage subsidence,7(13.0%) in group A and 9(42.9%) in group B. Among them,there were 3 of severe subsidence,1 in group A and 2 in group B. Conclusion The incidence of Cage subsidence in patients with irregular endplate morphology is significantly higher than those with regular endplate morphology after TLIF. Patients with irregular endplate morphology are prone to postoperative correction loss of intervertebral height and local lumbar lordosis angle.