腰椎终板形态对经椎间孔腰椎椎间融合术后融合器沉降的影响

Effect of Lumbar Endplate Morphology on Cage Subsidence after Transforaminal Lumbar Interbody Fusion

目的探讨不同腰椎椎间形态对经椎间孔腰椎椎间融合术(transforaminal lumbar interbody fusion,TLIF)后融合器沉降发生的影响。方法回顾性分析2019年1月至2021年8月接受单节段TLIF治疗的90例腰椎退行性疾病患者的临床和影像资料。根据影像资料,将患者分为沉降组43例,其中男15例,女28例,平均年龄(53.56±8.2)岁;未沉降组47例,其中男8例,女39例,平均年龄(58.26±13.53)岁。比较两组患者术前、术后、末次随访的影像参数(椎间隙高度、局部前凸角、终板形态参数、骨赘程度等)。再将患者分为无骨赘组46例,其中男15例,女31例,平均年龄(50.43±8.76)岁;骨赘组44例,其中男8例,女36例,平均年龄(61.84±11.18)岁。比较两组患者末次沉降度的差异。结果所有患者顺利完成手术,术后随访12~27个月,平均(14.5±3.6)个月。沉降组的椎体前缘骨赘、终板形态较未沉降组的退变程度更高;沉降组的椎间隙矫正度高于未沉降组;骨赘程度与沉降度呈负相关。以上差异有统计学意义(P<0.05)。结论终板形态不规则、椎间隙过度撑开的患者TLIF术后发生融合器沉降的可能性大;椎体前缘骨赘在维持TLIF术后局部节段稳定、避免融合器沉降方面具有积极意义。

Objective To investigate the effect of different lumbar intervertebral morphologies on the occurrence of cage subsidence after transforaminal lumbar interbody fusion(TLIF)via a posterior lateral foraminal approach.Methods The clinical and imaging data of 90 patients with degenerative lumbar spine diseases treated with single-segment TLIF from January 2019 to August 2021 were retrospectively analyzed.Based on the imaging data,the patients were divided into 43 cases in the subsidence group,including 15 men and 28 women with a mean age of(53.56±8.2)years,and 47 cases in the nonsubsidence group,including 8 men and 39 women with a mean age of(58.26±13.53)years.The patients in the two groups were compared in terms of preoperative,postoperative and final follow-up imaging parameters(intervertebral space height,local anterior convexity angle,endplate morphological parameters,degree of bone redundancy,etc.).The patients were then divided into two groups.There were 46 cases in the group without bone redundancy,of which 15 were male and 31 were female,with a mean age of(50.43±8.76)years,and there were 44 cases in the group with bone redundancy,of which 8 were male and 36 were female,with a mean age of(61.84±11.18)years.The difference in final subsidence was compared between the two groups.Results All patients completed the surgery successfully and were followed up for 12 to 27 months[(14.5±3.6)months]after surgery.The degree of degeneration of the anterior border of the vertebral body and the morphology of the endplate were higher in the subsidence group than in the nonsubmergence group,and the degree of intervertebral space correction was higher in the subsidence group than in the nonsubmergence group.The degree of bone fragmentation was negatively correlated with the degree of subsidence.The above differences were statistically significant(P<0.05).Conclusion Patients with irregular endplate morphology and over-supported intervertebral space have a higher likelihood of fusion subsidence after TLIF.Bone redundancy at the anterior edge of the vertebral body has positive significance in maintaining local segmental stability and avoiding fusion subsidence after TLIF.