后路椎弓根钉系统联合Cage融合术治疗腰椎退行性疾病并发症分析及防治

Analysis and preventive measures of complications of lumbar degenerative disease after posterior fusion by pedicle screw systems combined Cage

目的探讨后路椎弓根钉系统联合Cage融合术治疗腰椎退行性疾病的并发症及预防措施。方法2003～2008年对85例腰椎退行性疾病患者,经临床症状、体征和影像资料明确诊断且有手术指征,采用后路椎弓根钉系统联合Cage融合术治疗,对其中出现的并发症进行原因分析并提出预防措施。结果所有病例症状明显改善,术后1周按Nakai等评价标准:优53例;良17例;可13例;差2例。所有病例随访3～24个月,按Nakai评价标准:优56例;良22例;可6例;差1例。术后1周和最后随访时比较,差异无统计学意义(P>0.05)。85例中出现并发症19例,近期并发症有神经症状加重3例,脑脊液漏2例,感染2例;远期并发症有神经症状遗留4例,Cage位置偏移、下沉4例,椎间融合不确切2例,椎弓根钉松动2例。结论椎弓根钉技术和Cage椎间融合术联合应用可增加脊柱稳定性,提高植骨融合率,进而提高患者的远期疗效。但术后存在各种并发症,正确把握手术适应证、熟练掌握操作技巧、提高并发症的诊断及处理能力是顺利开展该技术、提高临床疗效的关键。

Objective To explore complications and their preventive measures of lumbar degenerative disease after posterior fusion by pedicle screw systems combined Cage.Methods A total of 85 cases of lumbar degenerative disease with definite diagnosis by clinical symptoms,signs and image data underwent posterior fusion by pedicle screw systems combined Cage.The reasons of the complications that occurred were analyzed,and prevention measures were put forward.Results The symptoms were improved in all the cases.According to Nakai criteria,optimal in 53 cases,good in 17 cases,ordinary in 13 cases,poor in 2 cases at 1 week postoperative.All the cases were followed up by 3-24 months.According to Nakai criteria,optimal in 56 cases,good in 22 cases,ordinary in 6 cases,poor in 1 case at the final follow-up.There was no statistical significance between the 2 groups（P0.05）.There were 19 cases of complications.The recent complications included 3 cases of neurologic symptoms aggravation,2 cases of cerebrospinal fluid leakage,2 cases of infection,and the long-term complications included 4 cases of neurologic symptoms remain,4 cases of Cage displacement or sinkage,2 cases of inexact fusion,2 cases of pedicle screws looseness.Conclusion The combined use of pedicle screws technology and intervertebral fusion with Cage can increase spinal stability,raise bone fusion rate and improve long-term curative effect.But there are various complications after operation,so correct understanding of indications,skillful mastering of techniques,improving the ability of diagnosis and treatment of the complications are the keys to develop this technique successfully and to improve curative effect.