| 腰椎斜外侧椎间融合术后融合器移位的发生特点与处理策略 |
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摘要点击次数: 97
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投稿时间：2024-01-25
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| 作者 | Author | 单位 | Address | E-Mail |
| 曾忠友 |
ZENG Zhong-you |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
zjzengzy@126.com |
| 赵兴 |
ZHAO Xing |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 |
Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 何登伟 |
HE Deng-wei |
丽水市中心医院脊柱外科, 浙江 丽水 323000 |
Department of Spine, Lishui Center Hospital, Lishui 323000, Zhejiang, China |
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| 张玙 |
ZHANG Yu |
皖南医学院戈矶山医院脊柱外科, 安徽 芜湖 241001 |
Department of Spine, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui, China |
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| 陈平泉 |
CHEN Ping-quan |
嘉兴市中医医院骨伤科, 浙江 嘉兴 314001 |
Department of Orthopaedics, Jiaxing TCM Hospital, Jiaxing 314001, Zhejiang, China |
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| 吴宏飞 |
WU Hong-fei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 俞伟 |
YU Wei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋永兴 |
SONG Yong-xing |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 范顺武 |
FAN Shun-wu |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 |
Department of Orthopaedics, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, Zhejiang, China |
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| 裴斐 |
PEI Fei |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 范时洋 |
FAN Shi-yang |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 宋国浩 |
SONG Guo-hao |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 王海峰 |
WANG Hai-feng |
武警海警总队医院骨二科, 浙江 嘉兴 314000 |
The Second Department of Orthopaedics, Hospital of Coast Guard General Corps of Armed Police Forces, Jiaxing 314000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2024年，第37卷，第12期，第1164-1172页 |
| DOI：10.12200/j.issn.1003-0034.20230340 |
| 基金项目:浙江省医药卫生科技计划项目(编号:2020KY968) |
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中文摘要:
目的: 探讨斜外侧椎间融合术(oblique lateral interbody fusion,OLIF)治疗腰椎病变术后融合器移位的特点、处理策略和预防措施。
方法: 回顾性分析4家医疗中心2014年10月至2018年12月采用OLIF治疗的12例腰椎病变术后出现融合器移位患者的临床资料,其中男4例,女8例;年龄53~81岁;腰椎间盘退行性病变2例,腰椎管狭窄症4例,腰椎退行性滑脱3例,腰椎退行性侧后凸3例;术前双能X线骨密度检测,T值>-1 SD 1例,T值-1~-2.5 SD 5例,T值<-2.5 SD 6例;单节段融合9例,2节段融合1例,3节段融合2例;采用Stand-alone OLIF 9例,OLIF联合后路椎弓根螺钉固定3例。分别于发生融合器移位时和末次随访时采用疼痛视觉模拟评分(visual analogue scale,VAS)、ODI功能障碍指数(Oswestry disability index,ODI)评价腰痛、腰椎功能恢复情况,并根据随访时影像结果观察融合器沉降或再移位、内固定有无松动或断裂,以及椎间融合情况,测量并比较发生融合器移位节段椎间隙高度变化。
结果: 再次手术的10例患者术后切口皮肤无坏死、无感染,12例患者获得随访,时间12~48个月。腰痛VAS由融合器移位时的3~8分降至末次随访时0~2分;ODI由发生融合器移位时的31%~51%恢复至末次随访时的5%~13%。随访过程中未出现椎弓根螺钉系统松动或断裂现象,11例采用融合器植骨患者均出现融合器沉降,融合器无进一步移位。椎间隙高度由发生融合器移位时的9.0~12.7 mm恢复至末次随访时的8.0~11.8 mm。末次随访时除1例没有影像结果外,其余均获得椎间融合。
结论: OLIF可用于腰椎病变的融合,术后存在融合器移位的风险,特别是多发生于术前存在骨量减少或骨质疏松、术中出现终板损伤,以及采用Stand-alone方式病例,且多发生于术后3个月内。对于初次手术采用Stand-alone OLIF方式所发生的融合器移位需要采取手术干预。虽然融合器移位经及时发现,确切处理,可获得良好的临床结果,但仍要强调术前病例的精准选择、OLIF方式的合适应用、术中的精细操作等预防融合器移位的措施。 |
| 【关键词】腰椎 固定 椎间融合 并发症 再手术 |
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| Characteristics and treatment measures of cages displacement after oblique lateral interbody fusion |
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ABSTRACT
Objective To explore characteristics,management strategies and preventive measures of fusion device displacement after oblique lateral interbody fusion (OLIF) in treating lumbar lesions.
Methods The clinical data of 12 patients with fusion device displacement after OLIF for lumbar lesions in 4 medical centers from October 2014 to December 2018 were retrospectively analyzed,including 4 males and 8 females,aged from 53 to 81 years old;2 patients with lumbar disc degeneration,4 patients with lumbar spinal stenosis,3 patients with lumbar degenerative spondylolisthesis and 3 patients with lumbar degenerative kyphosis;preoperative dual-energy X-ray bone mineral density (BMD) was detected in 1 patient with T-value >-1 SD,5 patients with T-value >-1~-2.5 SD,and 6 patients with T-value <-2.5 SD;9 patients with single-segment fusion,1 patient with 2-segment fusion,and 2 patients with 3-segment fusion;standalone OLIF was performed in 9 patients and OLIF combined with posterior pedicle screws in 3 patients. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate low back pain and lumbar function recovery at the time of fusion graft displacement and at the latest follow-up,respectively. In addition,according to imaging results during follow-up,the fusion device subsidence or redisplacement,loosening or fracture of internal fixation,and interbody fusion were observed,and the changes in the height of interbody space on the segment with fusion device displacement were measured and compared.
Results There were no necrosis or infection in skin incision of 10 patients after reoperation,and 12 patients were followed up for 12 to 48 months. VAS for low back pain decreased from 3 to 8 points at the time of fusion device displacement to 0 to 2 points at the latest follow-up. ODI recovered from 31% to 51% at the time of fusion transfer to 5% to 13% at the latest follow-up. There was no loosening or fracture of the pedicle screw system during follow-up. All 11 patients with bone grafting with fusion apparatus had fusion apparatus subsidence and no further displacement of fusion apparatus. The vertebral space height recovered from 9.0 to 12.7 mm at the time of fusion graft displacement to 8.0 to 11.8 mm at the latest follow-up. Interbody fusion was obtained in all patients except 1 with no imaging results at the latest follow-up.
Conclusion OLIF could be used for fusion of lumbar lesions,and there is a risk of fusion organ displacement after operation,especially in cases of bone loss or osteoporosis before surgery,end-plate injury during surgery,and Stand-alone mode,and most of them occur within 3 months after operation. Surgery is required for the transposition of the fusion apparatus in the Stand-alone OLIF mode during the primary operation. Although good clinical results could be obtained by timely detection and accurate treatment,it is still necessary to emphasize the precise selection of cases before operation,the appropriate application of OLIF,and precise operation during operation to prevent displacement of fusion device. |
| KEY WORDS Lumbar Fixed Interbody fusion Complications Reoperation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 曾忠友,赵兴,何登伟,张玙,陈平泉,吴宏飞,俞伟,宋永兴,范顺武,裴斐,范时洋,宋国浩,王海峰.腰椎斜外侧椎间融合术后融合器移位的发生特点与处理策略[J].中国骨伤,2024,37(12):1164~1172 |
| 英文格式: | ZENG Zhong-you,ZHAO Xing,HE Deng-wei,ZHANG Yu,CHEN Ping-quan,WU Hong-fei,YU Wei,SONG Yong-xing,FAN Shun-wu,PEI Fei,FAN Shi-yang,SONG Guo-hao,WANG Hai-feng.Characteristics and treatment measures of cages displacement after oblique lateral interbody fusion[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(12):1164~1172 |
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