腰椎后路椎间融合术后融合器脱出的原因分析

Cause analysis of cage retropulsion after posterior lumbar interbody fusion

背景:腰椎后路椎间融合术后融合器脱出发生率低,有关其原因分析的国内外文献报道较少。目的:探讨腰椎后路椎间融合术后融合器脱出的相关原因及预防措施。方法:回顾性分析2012年1月至2018年6月诊治的18例行腰椎后路椎间融合术后融合器向后脱出患者的临床资料,探讨融合器脱出的可能原因及其预防措施。结果:腰椎滑脱症8例,腰椎管狭窄症6例,腰椎间盘突出症4例;合并骨质疏松症6例,合并间质性肺炎、类风湿性关节炎需长期口服激素各1例;体重指数(BMI)正常8例,超重10例;融合器植入深度良好者7例,不良者11例;脱出节段植入1枚融合器者13例,植入2枚融合器者5例;椎弓根钉棒系统稳定性良好者13例,不良者5例;12例开始恢复工作的时间为术后6~26周,平均为术后16.7周,术后恢复工作至发现融合器脱出的时间为2~260周,平均27.9周。结论:腰椎后路椎间融合术后融合器脱出由多种因素所致,包括:腰椎滑脱未完全复位、合并骨质疏松症、肥胖、融合器类型选择不当、融合器型号偏小、融合器植入深度不良、单个椎间隙植入2枚融合器、椎弓根钉棒系统稳定性不良、术后过早恢复体力劳动等。

Background:The incidence of cage retropulsion after posterior lumbar interbody fusion is low and there are few reports about it in domestic and foreign literature.Objective:To investigate the correlation factors and preventive measures of cage retropulsion after posterior lumbar interbody fusion.Methods:The data of 18 patients with cage retropulsion after posterior lumbar interbody fusion diagnosed and treated from January 2012 to June 2018 were retrospectively analyzed in order to investigate the possible causes of cage retropulsion and its preventive measures.Results:Eight patients were diagnosed with lumbar spondylolisthesis,6 patients were diagnosed with lumbar spinal stenosis and 4 patients were diagnosed with lumbar disc herniation.There were 6 patients with osteoporosis,1 patient with interstitial pneumonia and 1 patient with rheumatoid arthritis requiring long-term oral administration of hormones.There were 8 patients with normal body mass index(BMI)and 10 patients with overweight BMI.The depth of cage implantation was good in 7 patients and bad in 11 patients.Thirteen patients were implanted with one cage and 5 patients were implanted with 2 cages at lumbar prolapsed segment.The stability of pedicle screw system was good in 13 patients and bad in 5 patients.Twelve patients started their work at the 6th to 26th weeks after surgery,with an average of 16.7 weeks.The time from resuming work postoperatively to the detection of cage retropulsion was 2 to 260 weeks,with an average of 27.9 weeks.Conclusions:Cage retropulsion after posterior lumbar interbody fusion is often caused by multiple factors,including incomplete reduction of lumbar spondylolisthesis,osteoporosis,obesity,unsuitable cage type,small cage size,improper implantation depth of cage,implantation of 2 cages into a single intervertebral space,poor stability of pedicle screw system and premature start of physical labor,etc.