后路腰椎椎间融合固定后融合器移位的成因及临床对策

After fixation with posterior lumbar interbody fusion cage shift causes and clinical strategy

目的通过对后路腰椎椎间融合固定后出现的融合器（Cage）移位的原因进行回顾性分析,提出临床预防对策。方法 2005-09-2010-09期间,实施后路腰椎椎间融合固定687例703个椎间隙,术后出现Cage移位17例,其中7例脊椎后侧移位,1例脊椎前侧移位,9例椎体内沉陷移位,X线检查发现Cage移位的时间2~19个月,平均1年。对此17例病例资料进行适应证的选择、手术操作、Cage的选择、患者自身因素等各种原因进行分析。结果术后Cage的移位与手术操作不规范、Cage的选择不合适、终板处理过度、术式选择不当、脊椎稳定性破坏及患者自身因素等有关。结论加强操作技术培训、掌握手术各环节的技巧、规范操作是关键;加强术前影像学的检查及适应证的选择是基础;术式和Cage的选择及置入技巧是重要环节;同时应注重患者自身疾病及术后处理。

Objective To analyze posterior lumbar interbody fusion by Cage fixation,after the fusionthe reasons for the cage shift retrospectively,and clinical preventive measures.Methods September 2005~September 2010 period,posterior lumbar interbody fusion to implement fixed 687 cases,703 intervertebral space,Cage shift occurred after 17 cases,including 7 cases of posterior spine displacement,1 case of anterior spine displacement,9 cases of subsidence within the vertebral body displacement,Cage X-ray examination found that the time of displacement,2 to 19 months,an average of 1 year.Data of 17 cases this choice of indications,surgical operations,choice of Cage such as the patient＇s own analysis of the causes.Results Cage after the shift and surgical operation was not standardized,Cage＇s choice is inappropriate,excessive end plate handling,improper choice of surgical procedures,spinal damage and the patient＇s own stability and other relevant factors.Conclusion Enhance operatiove and technical training to master all aspects of surgical techniques and standards is the key;enhance the preoperative imaging studies and is the basis for selection of indications;surgical and Cage selection and placement skills are an important part;at the same time should focus on a patient＇s own disease and postoperative treatment.