摘要
目的探讨腰椎融合术后融合器后移的原因及临床处理对策。方法回顾性分析2005年12月至2011年10月腰椎融合术后融合器后移至椎管的11例患者的完整资料，男7例，女4例；初次手术时年龄36-78岁，平均52.3岁。6例患者在初次手术后0．5-3个月，平均2．1个月椎问融合器发生后移（早期移位），5例患者在初次手术后14-36个月，平均24．8个月发生后移（晚期移位）。分析11例患者融合器后移发生原因，根据患者是否伴腰痛及下肢症状而行保守或手术治疗。结果早期移位发生原因与椎间隙处理不当、髓核残留过多、软骨终板刮除不足、融合器型号选择过小、融合器植入位置不当、固定强度不足等相关。晚期移位发生原因与手术方案选择不当、多节段融合固定、术前椎问节段存在不稳定、高龄、骨质疏松及合并糖尿病等有关。11例患者均获得随访，随访时间6-72个月，平均34个月；3例经保守治疗、8例接受翻修手术治疗均获得临床愈合。随访期间该组病例临床症状无明显加重，影像学随访未发现融合器再次移位、植骨不融合、椎弓根螺钉松动等并发症。结论腰椎融合术后融合器后移的发生原因复杂，移位发生时间的不同对移位原因的判断具有一定的临床价值；针对不同的移位原因、临床表现及影像学检查结果选择个性化方案进行治疗。
Objective To investigate causes and treatment strategy of cage retropulsion after lumbar interbody fusion. Methods Data of 11 patients with cage retropulsion after lumbar interbody fusion from December 2005 to October 2011 in our hospital were retrospectively analyzed. There were 7 males and 4 females. Their age ranged from 36 to 78 years （average, 52.3 years） at the time of the primary operation. Six cases occurred cage retropulsion 0.5 to 3 months after the primary operation, while 5 cases occurred cage retropulsion 14 to 36 months after the primary operation. The causes of cage retropulsion were analyzed. Moreover, corresponding managements were performed and results were recorded. Results The early cage retropulsion was associated with mismanagement of intervertebral space, too much residual of nucleus pulposus, insufficient erasion of cartilage end plate, too small size of cage, malposition of cage, insufficient fixation and so on. The late cage retropulsion was associated with improper choice of surgical strategies, muhi-level fusion, preoperative unsteady of vertebrae, advanced age, osteoporosis, diabetes and so on. Three patients underwent conservative treatment and 8 patients underwent revision surgery. All 11 patients were followed up for 6 to 72 months （average, 34 months）. There was no re-migration of cage, fusion failure, pedicle screw loosening and other complications during the follow-up period. Conclusion The causes of cage retropulsion after lumbar interbody fusion were complex and diverse, and the time of cage retropusion had some clinical value for the cause analysis. It was more advisable to make an individualized treatment program based on the causes of cage retropulsion, clinical manifestations and imaging results.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第10期916-921,共6页
Chinese Journal of Orthopaedics
关键词
腰椎
脊柱融合术
手术后并发症
Lumbar vertebrae Spinal fusion Postoperative complications
