摘要
目的探讨腰椎椎间融合术后融合器后移的原因及再手术策略。方法回顾性分析2009年1月至2015年2月间收治因腰椎椎间融合术后融合器退出再手术9例患者的病历资料，男4例，女5例；年龄38-75岁，平均61．6岁。所用融合器类型：钛金属矩形融合器3例，聚醚醚酮矩形融合器（PEEK）5例，圆柱状螺纹融合器1例。单侧椎弓根螺钉固定2例，双侧椎弓根螺钉固定7例。分析总结融合器移位退出发生原因，再次彻底处理椎间隙，行椎体间融合固定术重新置入新的融合器。术后定期随访观察影像学结果及临床疗效。结果椎间融合器退出发生原因：椎间隙髓核残留过多6例、软骨终板刮除不足4例、融合器型号选择过小5例、融合器植入位置欠佳2例、手术方案选择不当1例。9例患者再次手术后均获得随访，随访时间6-32个月。随访期间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，临床症状均获得不同程度的改善。结论腰椎椎间融合术后融合器退出的发生原因复杂，可能主要与椎间隙处理不彻底、融合器型号选择不当及融合器放置位置欠佳有关，并非因单侧固定引起，合理的再手术可获得可靠的椎间融合及良好的临床疗效。
Objective To investigate cause analysis and treatment strategy of cage migration after lumbar interbody fusion. Methods Retrospective study was performed on 9 cases with cage migration after lumbar interbody fusion from January 2009 to February 2015 in our hospital. There were 4 males and 5 females, and mean age was 61.6 years （rang, 38-75 years）. The types of cage included Titanium metal cage used in 3 cases, cylindrical thread cage in 1 case and PEEK cage in the other cases. Bilateral instrumented posterior lumbar interbody fusion was found in 7 cases, and unilateral fixation in 2 cases. Analyze the risk factors of cage migration and the strategies of revision surgery, and evaluate the radiological outcomes and clinical efficacy of revision surgery. Results Risk factors of cage backward migration are as follows： nucleus pulposus left too much in 6 cases, poor cartilage endplate resection in 4 cases, small size of cage selection in 5 cases, unsatisfied cage placement in 2 cases, and improper operation in 1 case. Follow-up survey was fulfilled in all patients, the follow-up time was 6 to 32 months, and bony union was detected in all patients. No cage re-migration, non-fusion, or loosen pedicle screw was found during follow-up period. Clinical symptoms were all improved after revision. Conclusion The causes of cage migration after bilateral or unilateral instrumented transforaminal lumbar interbody fusion were complicated. Risk factors of cage migration may be poor intervertebral space preparation, small cage size, and improper cage placement, which may be not associated with unilateral fixation. Excellent or good radiological outcomes and clinical efficacy depend on a reasonable revision surgery.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2016年第17期1093-1098,共6页
Chinese Journal of Orthopaedics
基金
国家自然科学基金（81572168）
上海市科委2013年度产学研医合作项目（13DZ1940504,13DZ1940505）
关键词
腰椎
脊柱融合术
手术后并发症
Lumbar vertebrae
Spinal fusion
Postoperative complications
