腰椎后路椎间植骨融合器后移的危险因素

目的探讨腰椎后路椎间植骨融合器后移的危险因素,以有助于完善预防措施。方法回顾性分析2011年1月—2013年5月在本院接受单节段或多节段腰椎后路减压椎弓根钉棒内固定椎间植骨融合术(简称腰椎后路椎间植骨融合术)治疗的238例患者的完整病历及影像学资料,共280个节段,278枚椎间融合器(Cage)。患者年龄42~76岁,平均56.9岁;平均手术节段1.4个(1~4个);随访时间12~24个月,平均20.3个月。根据术后是否出现突然的腰痛和下肢症状决定非手术治疗或行翻修手术。结果本研究组中Cage后移7例,Cage7枚,均发生在L4/L5节段。Cage后移发生在术后1~3个月,平均1.6个月,7例患者均未因Cage后移出现腰痛或下肢症状,所有患者未行翻修手术。结论 Cage后移的危险因素有使用Cage型号过小、Cage无角度、直线型终板、术前椎间隙前后缘高度过大及合并退行性侧凸等。

Risk factors of Cage retropulsion after posterior lumbar interbody fusion

Objective To analyze the risk factors of Cage retropulsion after posterior lumbar interbody fusion, and to improve the preventive measures. Methods Data of 238 cases(280 disc levels, 278 Cages), who underwent either mono-or multi-segmental posterior lumbar interbody fusion from January 2011 to May 2013, were retrospectively analyzed. Their age ranged 42-76 years(mean 56.9 years) at the time of the operation. The mean fusion level was 1.4(ranged 1-4). The follow-up time ranged 12-24 months(mean 20.3 months). Depending on whether a sudden low back pain or lower extremity symptoms occurred after the operation, non-operative treatment or revision surgery was chosen to perform. Results Postoperative Cage retropusion was found in 7 cases(7 Cages) at L₄/L₅. All the Cage retropulsions were found between 1 to 3 months(mean 1.6 months) after operation. None of the 7 cases had low back pain or leg pain, so none of them underwent revision surgery. Conclusion The results suggest that the undersized fusion Cages, Cages without lordosis angle, linear type endplate, preoperative higher anterior and posterior disc height, as well as combining degenerative scoliosis might be the risk factors for Cage retropulsion.