腰椎间盘突出症术后早期椎间融合器松动原因分析和预防

Analyzing and preventing loose causes of early postoperative intervertebral fusion of lumbar disc herniation

目的探讨腰椎间盘突出症采取椎间融合器融合术后早期（3个月内）出现椎间融合器松动后移的原因及预防方法。方法回顾性分析2007年1月—2014年1月期间开展的268例腰椎间盘突出症采取后路减压椎间融合术患者，出现早期椎间融合器松动的患者10例。对10例早期椎间融合器松动患者的临床资料进行分析研究，观察椎间融合器松动病例的年龄大小情况、是否早期下地活动的情况、椎间融合器初始位置情况、椎体终板处理情况、椎间隙前追加植骨情况、横连杆的应用情况、术后感染情况及处理方案等指标，进行数据分析研究，采取Excel处理。结果椎间融合器松动的10例病例中，患者年龄26～58岁，平均年龄43．2岁，1个月内下地的患者有6例（60％），椎间融合器初始位置偏后的患者有7例（70％），终板处理不良的患者有7例（70％），椎间隙前未追加植骨的患者有2例（20％），未使用横连杆的患者有7例（70％），术后感染的患者有2例（20％）。结论经过研究分析认为较年轻的患者、过早的下地活动、椎间融合器初始位置不良、终板处理不良造成椎间融合器贴合不佳、椎间隙前未追加植骨或不良、不使用横连杆以及术后发生感染等可能是造成腰椎间盘突出术后出现早期椎间融合器松动的原因。

Objective To investigate the causes and prevention methods of lumbar disc herniation after lumbar interbody fusion （ within three months）. Methods A retrospective analysis of 268 patients with lumbar disc herniation in the peri- od from January,2007 to January,2014 was carried out in 10 patients with early stage interbody fusion and posterior de- compression and interbody fusion. Ten cases of patients with early fusion cage loose clinical data were analyzed. The ob- servation intervertebral fusion device loosening were age, activity time, interbody fusion device initial position, endplate disposition, additional disc space before graft, application of the cross connecting rod, infection and treatment of index were analyzed. Results Cases of intervertebral fusion device loose, patients aged 26 to 58 years, mean age 43.2 years; one month within the proportion of patients with 6 cases （60%） ;interbody fusion device initial position after partial with 4 cases （40%） ,plate processing bad with 7 cases （70%） ;no additional disc space before the patient＇ s bone with 2 ca- ses （20%） ;without the use of a transverse connecting rod accounted with 7 cases （70%） ; postoperative infection in 2 cases （20%）. Conclusion These results indicate that younger patients, early activity and interbody fusion in poor ini- tial location and endplate preparation adverse caused by intervertebral fusion device attached to the poor, no additional disc space before bad bone,without using a transverse connecting rod and infection may be caused by lumbar disc hernia- tion surgery appears early intervertebral fusion device loosening.