| 腰椎斜外侧椎间融合术后融合器沉降的原因分析 |
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Received:January 19, 2023
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| 作者 | Author | 单位 | Unit | 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 |
| 陈平泉 |
CHEN Ping-quan |
嘉兴市中医医院骨伤科, 浙江 嘉兴 314001 |
Department of Orthopaedics and Traumatology, Jiaxing TCM Hospital, Jiaxing 314001, Zhejiang, China |
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| 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, Run Run Show Hospital Affiliated to Zhejiang Univerisity School of Medicine, Hangzhou 30016, 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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| 张建乔 |
ZHANG Jian-qiao |
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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| 方向前 |
FANG Xiang-qian |
浙江大学医学院附属邵逸夫医院骨科, 浙江 杭州 310016 |
Department of Orthopaedics, Run Run Show Hospital Affiliated to Zhejiang Univerisity School of Medicine, Hangzhou 30016, 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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| 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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| 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, Run Run Show Hospital Affiliated to Zhejiang Univerisity School of Medicine, Hangzhou 30016, 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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| 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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| 期刊信息：《中国骨伤》2024年37卷，第1期，第33-44页 |
| DOI：10.12200/j.issn.1003-0034.20220378 |
| 基金项目:浙江省医药卫生科技计划项目(编号:2020KY968) |
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目的:观察斜外侧椎间融合(oblique lateral interbody fusion,OLIF)治疗腰椎病变术后融合器沉降现象,总结融合器沉降特点,并分析其原因,提出预防性措施。
方法:回顾性分析2015年10月至2018年12月收治的144例腰椎病变资料,其中男43例,女101例;年龄20~81(60.90±10.06)岁;腰椎间盘退行性病变17例,巨大型腰椎间盘突出12例,椎间盘源性腰痛5例,腰椎管狭窄症33例,腰椎退行性滑脱26例,腰椎椎弓峡部裂伴椎体滑脱28例,腰椎内固定术后邻椎病11例,炎症转归期原发性椎间隙炎7例,腰椎退行性侧后凸5例。术前双能X线骨密度检查提示存在骨量减少或骨质疏松57例,骨密度正常87例。融合节段数:单节段124例,2节段11例,3节段8例,4节段1例。采用Stand-alone OLIF 40例,OLIF联合后路椎弓根螺钉固定104例。记录术后融合器沉降的发生情况,对可能风险因素进行单因素分析,观察融合器沉降对于临床结果的影响。
结果:所有手术顺利完成,手术时间中位数99 min,术中出血量中位数106 ml;术中发生终板损伤30例,合并椎体骨折5例。所有患者获得随访,时间6~30(14.57±7.14)个月。随访过程中除原发性腰椎间隙炎病例、部分腰椎椎弓峡部裂伴椎体滑脱病例,其余出现不同程度的融合器沉降现象,其中正常沉降119例,异常沉降25例(Ⅰ级23例,Ⅱ级2例)。未出现椎弓根螺钉系统松动或断裂现象,椎间隙高度由术前的(9.48±1.84) mm恢复至术后3~5 d的(12.65±2.03) mm及末次随访时的 (10.51±1.81) mm,术后3~5 d与术前比较、末次随访与术后3~5 d比较差异均有统计学意义(P<0.05)。椎间融合率为94.4%(136/144)。腰痛和腿痛视觉模拟评分(visual analogue scale,VAS)分别由术前的(6.55±2.29)、(4.72±1.49)分降低至末次随访时的(1.40±0.82)、(0.60±0.03)分(P<0.000 1);ODI由术前的(38.50±6.98)%恢复至末次随访时的(11.30±3.27)%(P<0.05)。并发症发生率为31.3%(45/144),再手术率9.72%(14/144),其中因融合器沉降或移位而再次手术8例,占再手术的57.14%(8/14)。单因素分析结果显示:在骨量减少或骨质疏松组、Stand-alone OLIF组、2节段或以上融合组、终板损伤组中其异常沉降例数分别高于骨量正常组、OLIF联合椎弓根螺钉固定组、单节段融合组、终板无损伤组。
结论:融合器沉降是OLIF术后较为常见的现象,术前骨量减少或骨质疏松、Stand-alone OLIF应用、2节段或以上融合和术中终板损伤可能是术后融合器沉降的重要因素。虽然融合器沉降程度与临床症状无明显相关,但存在融合器移位的风险,需要加强预防,以降低因融合器沉降而带来的严重并发症,包括再手术。 |
| [关键词]:腰椎 固定 椎间融合 终板损伤 融合器沉降 融合器移位 再手术 |
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| Analysis of the causes of cage subsidence after oblique lateral lumbar interbody fusion |
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Abstract:
Objective To observe the cage subsidence after oblique lateral interbody fusion (OLIF) for lumbar spondylosis,summarize the characteristics of the cage subsidence,analyze causes,and propose preventive measures.
Methods The data of 144 patients of lumbar spine lesions admitted to our hospital from October 2015 to December 2018 were retrospectively analyzed. There were 43 males and 101 females,and the age ranged from 20 to 81 years old,with an average of (60.90±10.06) years old. Disease types:17 patients of lumbar intervertebral disc degenerative disease,12 patients of giant lumbar disc herniation,5 patients of discogenic low back pain,33 patients of lumbar spinal stenosis,26 patients of lumbar degenerative spondylolisthesis,28 patients of lumbar spondylolisthesis with spondylolisthesis,11 patients of adjacent vertebral disease after lumbar internal fixation,7 patients of primary spondylitis in the inflammatory outcome stage,and 5 patients of lumbar degenerative scoliosis. Preoperative dual-energy X-ray bone mineral density examination showed 57 patients of osteopenia or osteoporosis,and 87 patients of normal bone density. The number of fusion segments:124 patients of single-segment,11 patients of two-segment,8 patients of three-segment,four-segment 1 patient. There were 40 patients treated by stand-alone OLIF,and 104 patients by OLIF combined with posterior pedicle screw. Observed the occurrence of fusion cage settlement after operation,conducted monofactor analysis on possible risk factors,and observed the influence of fusion cage settlement on clinical results.
Results All operations were successfully completed,the median operation time was 99 min,and the median intraoperative blood loss was 106 ml. Intraoperative endplate injury occurred in 30 patients and vertebral fracture occurred in 5 patients. The mean follow-up was (14.57±7.14) months from 6 to 30 months. During the follow-up,except for the patients of primary lumbar interstitial inflammation and some patients of lumbar spondylolisthesis with spondylolisthesis,the others all had different degrees of cage subsidence. Cage subsidence classification:119 patients were normal subsidence,and 25 patients were abnormal subsidence (23 patients were gradeⅠ,and 2 patients were gradeⅡ). There was no loosening or rupture of the pedicle screw system. The height of the intervertebral space recovered from the preoperative average (9.48±1.84) mm to the postoperative average (12.65±2.03) mm,and the average (10.51±1.81) mm at the last follow-up. There were statistical differences between postoperative and preoperative,and between the last follow-up and postoperative. The interbody fusion rate was 94.4%. The low back pain VAS decreased from the preoperative average (6.55±2.2 9) to the last follow-up (1.40±0.82),and there was statistically significant different. The leg pain VAS decreased from the preoperative average (4.72±1.49) to the final follow-up (0.60±0.03),and the difference was statistically significant (t=9.13,P<0.000 1). The ODI index recovered from the preoperative average (38.50±6.98)% to the latest follow-up (11.30±3.27)%,and there was statistically significant different. The complication rate was 31.3%(45/144),and the reoperation rate was 9.72%(14/144). Among them,8 patients were reoperated due to fusion cage subsidence or displacement,accounting for 57.14%(8/14) of reoperation. The fusion cage subsidence in this group had obvious characteristics. The monofactor analysis showed that the number of abnormal subsidence patients in the osteopenia or osteoporosis group,Stand-alone OLIF group,2 or more segments fusion group,and endplate injury group was higher than that in the normal bone mass group,OLIF combined with pedicle screw fixation group,single segment fusion group,and no endplate injury group,and the comparison had statistical differences.
Conclusion Cage subsidence is a common phenomenon after OLIF surgery. Preoperative osteopenia or osteoporosis,Stand-alone OLIF,2 or more segments of fusion and intraoperative endplate injury may be important factors for postoperative fusion cage subsidence. Although there is no significant correlation between the degree of cage subsidence and clinical symptoms,there is a risk of cage migration,and prevention needs to be strengthened to reduce serious complications caused by fusion of cage subsidence,including reoperation. |
| KEYWORDS:Lumbar vertebra Fixation Intervertebral fusion Endplate injury Cage subsidence Cage migration 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,陈平泉,赵兴,吴宏飞,张建乔,方向前,宋永兴,俞伟,裴斐,范顺武,宋国浩,范时洋.腰椎斜外侧椎间融合术后融合器沉降的原因分析[J].中国骨伤,2024,37(1):33~44 |
| 英文格式: | ZENG Zhong-you,CHEN Ping-quan,ZHAO Xing,WU Hong-fei,ZHANG Jian-qiao,FANG Xiang-qian,SONG Yong-xing,YU Wei,PEI Fei,FAN Shun-wu,SONG Guo-hao,FAN Shi-yang.Analysis of the causes of cage subsidence after oblique lateral lumbar interbody fusion[J].zhongguo gu shang / China J Orthop Trauma ,2024,37(1):33~44 |
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