经椎间孔入路腰椎椎间融合术中融合器位置对融合器沉降的影响  

Effect of cage location in transforaminal lumbar interbody fusion on postoperative cage subsidence

作　　者：黄诚谦[1] 韦文[1] 陆文忠[1] 赵勇[1] 李新武[1] HUANG Cheng-qian;WEI Wen;LU Wen-zhong;ZHAO Yong;LI Xin-wu(Department of Spinal Surgery,People’s Hospital of Baise,Baise 533000,Guangxi ZhuangAutonomous Region,China)

机构地区：[1]百色市人民医院脊柱外科

出　　处：《脊柱外科杂志》2019年第3期177-182,共6页Journal of Spinal Surgery

摘　　要：目的 评估经椎间孔入路腰椎椎间融合术(TLIF)中融合器位置对融合器沉降发生率的影响。方法 回顾性分析2010年1月—2014年12月接受L4/L5单节段TLIF的83例腰椎退行性疾病患者的临床和影像学资料。根据术后即刻CT平扫上融合器与L5椎体上终板的相对位置,将患者分为中央组(37例)与边缘组(46例),比较2组患者手术前后影像学参数(椎间隙高度、椎间孔高度、腰椎局部前凸角)及疼痛视觉模拟量表(VAS)评分等指标。结果2组患者术后即刻、末次随访时椎间隙高度、椎间孔高度及腰椎局部前凸角较术前明显升高,差异均有统计学意义(P<0.05);末次随访时,中央组患者椎间隙高度、腰椎局部前凸角较术后即刻均有明显丢失,差异均有统计学意义(P<0.05);末次随访时,边缘组患者椎间隙高度、腰椎局部前凸角显著高于中央组,差异均有统计学意义(P<0.05)。末次随访时,2组患者腰痛及下肢痛VAS评分较术前均明显改善,差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05)。末次随访时共18例发生融合器沉降,中央组12例(32.4%),1例重度沉降,11例轻度沉降;边缘组6例(13.0%)均为轻度沉降,2组沉降率差异有统计学意义(P<0.05)。结论 TLIF中融合器位于终板中央区域会增加术后融合器沉降发生率,术中置入融合器时应放置于终板边缘区域,以降低术后融合器沉降的风险。Objective To evaluate the effect of cage location in transforaminal lumbar interbody fusion(TLIF)on postoperative cage subsidence.Methods From January 2010 to December 2014,the clinical and imaging data of 83 patients with lumbar degenerative diseases receiving L4/L5 single-segment TLIF were retrospectively analyzed.According to the relative positions of the cage and the upper endplate of L5 vertebral body on the immediate postoperative CT scan,the patients were divided into the central group(37 cases)and the marginal group(46 cases).The imaging parameters(intervertebral height,foramenal height,local lumbar lordosis angle)and visual analogue scale(VAS)score were compared between the 2 groups at pre-operation and post-operation.Results The intervertebral height,foramenal height and local lumbar lordosis angle in the 2 groups were significantly increased at immediate post-operation and final follow-up,with statistical significances(P<0.05).At the final follow-up,the intervertebral height and local lumbar lordosis angle in the central group were significantly lost compared with those immediate post-operation,and the differences were statistically significant(P<0.05).At the final follow-up,the intervertebral height and local lumbar lordosis angle in the marginal group were significantly higher than those in the central group,with statistical significances(P<0.05).At the final follow-up,the VAS scores of low back pain and lower limb pain in the 2 groups were significantly improved compared with those before the operation,with statistical significances(P<0.05),but there was no significant difference between the 2 groups(P>0.05).At the final follow-up,a total of 18 patients had cage subsidence,12(32.4%)in the central group,severe subsidence in 1,mild subsidence in 11;6 patients(13.0%)in the marginal group had mild subsidence;and the difference between the 2 groups was significant(P<0.05).Conclusion In TLIF,the placement of cage in the central area of the endplate will increase the incidence of cage subsidence after oper

关 键 词：腰椎 椎间盘移位 脊椎滑脱 手术后并发症 

分 类 号：R681.533[医药卫生—骨科学]