腰椎椎间融合术后笼架后移危险因素分析  

Factors related to cage displacement after lumbar interbody fusion

作　　者：王丹[1] 蔡贤华[1] 徐峰 蒋欣浩 黄威 袁彪 WANG Dan;CAI Xian-hua;XU Feng;JIANG Xin-hao;HUANG Wei;YUAN Biao(Hubei University of Chinese Medicine,Wuhan 430065,China;Department of Spine Surgery,The Second Peo-ple􀆳s Hospital of Jingmen City,Jingmen 448000,China;Department of Orthopaedics,General Hospital of PLA Central Theater,Wuhan 430070,China)

机构地区：[1]湖北中医药大学,湖北武汉430065 [2]荆门市第二人民医院脊柱外科,湖北荆门448000 [3]解放军中部战区总医院骨科,湖北武汉430070

出　　处：《中国矫形外科杂志》2021年第14期1264-1268,共5页Orthopedic Journal of China

摘　　要：[目的]探讨腰椎椎间融合术后笼架后移危险因素。[方法]回顾分析692例腰椎后路椎间融合手术患者临床资料。将患者性别、年龄、合并症、住院天数、支具佩戴时间、椎间隙高度恢复情况、笼架置入深度、椎弓根钉棒稳定情况、椎间隙前凸角恢复情况纳入分析,采用单项因素与二元多因素逻辑回归分析笼架后移的相关因素。[结果] 629例患者中,发生笼架移位的23例,占3.32%。单项因素分析表明:与未后移组相比,后移组年龄大、术后佩戴支具时间短、椎间盘突出症比率低、骨质疏松比率高、激素使用比率高、超重比率高、双节段融合比率高、术后椎间隙高度恢复不良比率高、术后前凸角恢复不良比率高、术后笼架置入深度不良比率高、术后椎弓根钉棒系统稳定不良比率高,差异均有统计学意义(P<0.05)。逻辑回归表明:术后佩戴支具时间是笼架后移的保护因素(OR=0.374,P<0.001)。而术后椎间隙高度恢复不良(OR=263.109,P<0.001),笼架置入深度不良(OR=27.931,P<0.001),骨质疏松症(OR=13.609,P=0.007)和超重(OR=8.133,P=0.038)是笼架后移的危险因素。[结论]腰椎椎间融合术后笼架后移由多因素导致。骨质疏松、超重、术后椎间隙高度恢复不良、笼架置入深度不良和术后佩戴支具时间为笼架后移独立影响因素。[Objective] To explore the factors related to cage displacement backward after lumbar interbody fusion. [Methods] A retrospective study was conducted on 692 patients who underwent posterior lumbar interbody fusion. The patient’s gender, age, comorbidities,hospitalization days, brace wearing time, intervertebral space height recovery, depth of cage implantation, pedicle screw-rod stability, and intervertebral lordotic angle recovery were included as variables in this analysis. The univariable analysis and binary multi-factor logistic regression were conducted to search the factors related to cage displacement backward. [Results] Among 629 patients, 23 patients were proved cage displacement definitively, accounting for 3.32%. In term of univariable analysis, the patients who proved of cage displacement had older age, shorter postoperative bracing time and lower ratio of intervertebral disc herniation, whereas higher ratios of osteoporosis, glucocorticoid used, overweight, two-segment fusion, poor postoperative intervertebral space height recovery, poor postoperative lordotic angle recovery, poor cage implantation depth and poor postoperative pedicle screw and rod system stability than those who were of non-displacement cage, which all were statistically significant(P<0.05). As results of logistic regression, time of wearing the brace after the operation was a protective factor for the cage displacement backward(OR=0.374, P<0.001), whereas the poor postoperative intervertebral space height recovery(OR=263.109, P<0.001), poor cage implantation depth(OR=27.931, P<0.001), osteoporosis(OR=13.609, P=0.007) and overweight(OR=8.133, P=0.038) were the risk factors for the cage displacement backward. [Conclusion] The cage displacement backward after lumbar interbody fusion is caused by multiple factors. Osteoporosis, overweight, poor postoperative intervertebral space height recovery, poor cage implantation depth, and postoperative bracing time are independent factors related to cage displacement in this study.

关 键 词：腰椎椎间融合术 笼架 后移 并发症 

分 类 号：R687[医药卫生—骨科学]