摘要
目的探讨腰椎后路椎间融合术后融合器后移的原因和临床处理策略，尤其是间隙上终板后部损伤与术后融合器后移的相关性。方法回顾性分析2011年8月至2014年7月行经椎间孔腰椎椎间融合术（transforaminallumbarin．terbodyfusion，TLIF）术后出现融合器后移至椎管的7例患者的资料，男4例，女3例；年龄45～74岁，平均（53．6±10．2）岁。于术后第3天行腰椎正位、侧位X线片及CT扫描重建检查，于术后3、6、12个月进行随访。分析7例患者融合器后移的发生原因、临床特点和处理策略。结果7例融合器后移均发生在术后3个月内（15-67d）。每例均在术后第3天腰椎CT扫描矢状位重建图像中发现减压侧融合间隙上终板的后部损伤，该损伤致使后方椎间隙增大。融合器后移与间隙上终板后部损伤密切相关，同时还可能合并了术前终板形态、减压前未行对侧间隙预撑开、钉棒系统加压不足等因素。7例患者无明显腰腿痛症状或仅诉轻微腰痛症状，予以卧床休息、限制活动、口服消炎镇痛药物等保守治疗。随访12个月后未见临床症状或融合器后移程度明显加重。结论终板损伤导致的融合节段椎间隙后方高度增大是发生融合器后移的关键因素，而梨形终板形态可能叠加了这种风险；减压侧行椎间融合操作前未行对侧椎间隙预撑开、椎间撑开器的旋转、试模及融合器的撞击可能是造成终板后部损伤的原因，因此预防术中融合间隙终板的医原性损伤可能是杜绝融合器后移发生的主要手段。
Objective To investigate causes and treatment strategy of cage retropulsion after lumbar interbody fusion, in particular the correlations between the injury of the posterior part of endplate cranially adjacent to fusion and cage retropulsion. Methods Data of 7 patients with cage migration after lumbar interbody fusion from August 2011 to July 2014 in our hospital were retrospectively analyzed. There were 4 males and 3 females, aged from 45-74 years （average, 53.6 years）. All patients took X- ray and CT scans examinations 3 d postoperatively, and they were followed up at 3, 6, 12 months after operation. The characteris- tics of the patients and the injury of the endplate adjacent to fusion were analyzed to identify possible risk factors of cage retropul- sion. Moreover, corresponding managements were performed and outcomes were recorded. Results All 7 cases of cage retropul- sion occurred within 3 months post-operatively （rang, 15-67 d）. Posterior part of the endplate superiorly neighboring to fusion was found injured on the decompression side in all cases with cage retropu]sion, and that led to an increase in the posterior interverte- bral space height at the fusion segment. Other factors, including pear-shape type endplate, and improper operative manipulations may add the risk of cage retropulsion. These 7 patients complained mild back pain or no back pain, and received corresponding treatments including bed rest, activity limitation, and oral administration of anti-inflammatory analgesics. The clinical symptoms and degrees of cage retropulsion were not aggravated during follow-up. Conclusion The injury of the posterior margin of end- plate superiorly neighboring to fusion on the decompression side which caused increased posterior intervertebral space height may be key to postoperative cage retropulsion. Prevention of possible iatrogenie injury to the endplate may be effective to reduce the risk of cage retropulsion.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第14期914-920,共7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
