置入椎间融合器行腰椎融合后Cage移位的原因

中国组织工程研究与临床康复第15卷第39期 2011–09–24出版

Journal of Clinical Rehabilitative Tissue Engineering Research September 24, 2011 Vol.15, No.39 ISSN 1673-8225 CN 21-1539/R CODEN: ZLKHAH

7307 Department of Orthopaedics, the

Third Xiangya

Hospital of Central South University, Changsha 410013, Hunan Province,

China

Miao Jing-lei★, Master, Attending physician,

Department of Orthopaedics, the

Third Xiangya

Hospital of Central South University, Changsha 410013, Hunan Province,

China

miaojinglei@

Received: 2011-04-11 Accepted: 2011-06-21

中南大学湘雅三

医院骨科，湖南省

长沙市 410013

苗惊雷★，男，1977年生，河南

省濮阳市人，2003年中南大学

毕业，硕士，主治

医师，主要从事脊

柱外科方面的研究。

miaojinglei@

中图分类号:R318

文献标识码:B

文章编号:1673-8225 (2011)39-07307-04

收稿日期：2011-04-11 修回日期：2011-06-21 (20110411006/M·W)

置入椎间融合器行腰椎融合后Cage移位的原因★

苗惊雷，张朝跃，詹瑞森，李志跃，刘振东

Cause analysis of Cage displacement after posterior lumber interbody fusion

Miao Jing-lei, Zhang Chao-yue, Zhan Rui-sen, Li Zhi-yue, Liu Zhen-dong

Abstract

BACKGROUND: Cage displacement is a serious complication after posterior lumber interbody fusion， which often requires reoperation. However, revision surgery is difficult and its effect is uncertain.

OBJECTIVE: To analyze and summarize the correlation factors affecting the displacement of Cage.

METHODS: A retrospective analysis was conducted in 16 cases of Cage displacement in the Third Xiangya Hospital of Central South University and 4 cases from other hospitals between January 2004 and January 2010. We observed and measured the following indexes: the number and depth of implanted Cage, the fitness of Cage and vertebral endplate, the fastness of the pedicle screw system and the hight of intervertebral space.

RESULTS AND CONCLUSION: Single cage was used in lumbar interbody fusion in 9 patients, and other 11 cases were implanted double cages. Insufficient depth of implanted cage was found in 12 patients and unfitness of cage and vertebral endplate was found in 10 patients. Eight cases had the problem of insufficient recovery of the lesion intervertebral height. Pedicle screw fixation was wrong in location in 2 patients, and loosed in 6 patients. Some aspects relating to internal implants, such as design and choice of cage, and the depth of implantation of cage, as well as the fastness of the pedicle screw system, may have effects on the stability of cage.

Miao JL, Zhang CY, Zhan RS, Li ZY, Liu ZD.Cause analysis of Cage displacement after posterior lumber interbody

fusion.Zhongguo Zuzhi Gongcheng Yanjiu yu Linchuang Kangfu. 2011;15(39): 7307-7310.

[ ]

摘要

背景：多数情况下行后路腰椎椎间融合患者发生Cage移位需再次手术翻修，但翻修手术难度大，效果也常不确切。

目的：分析影响后路腰椎椎间融合后Cage移位的相关因素。

方法：回顾性分析中南大学湘雅三医院2004-01/2010-01进行后路腰椎椎间融后发生Cage移位的16例患者及由外院转入的4例同类患者的临床资料，观测病变节段内置入Cage的数目、Cage的置入深度、Cage与椎体终板贴合程度、椎弓根钉系统的稳定性及病变节段椎间隙高度恢复情况等指标。

结果与结论：病变节段使用单枚Cage融合9例，使用双Cage融合11例。Cage置入深度不足者12例，Cage与椎体终板贴合不佳者10例、病变节段椎间隙高度未恢复者8例，椎弓根钉置入位置错误者2例，椎弓根钉螺帽松动者4例。结果说明 Cage的设计、选择、初始置入位置，椎间隙高度的恢复及配合应用椎弓根钉系统的情况可能影响Cage在宿主体内的稳定性。

关键词：腰椎；脊柱融合术；椎间融合器；内固定器；植入体

doi:10.3969/j.issn.1673-8225.2011.39.022

苗惊雷，张朝跃，詹瑞森，李志跃，刘振东.置入椎间融合器行腰椎融合后Cage移位的原因[J].中国组织工程研究与临床康复，2011，15(39):7307-7310. [ ]

0 引言

椎间融合器(Cage)设计是基于“撑开-压缩”原理，即利用Cage置入的撑开力使纤维环、前后纵韧带处于张力状态，结合骶棘肌收缩产生的压缩力使Cage稳定于椎间隙。Cage早期应用于临床时，多数病例未附加内固定，随访发现部分患者出现Cage沉降、移位，为避免这种情况的发生，在使用椎弓根螺钉系统后，这种“撑开-压缩”作用可由椎弓根螺钉系统配合完成，在椎节各个方向上的应力和稳定性都得到加强[1-4]。但随着临床上开展病例数的增多及随访时间的延长，作者发现这并非解决Cage移位问题的最终方法，临床上仍可观察到联合应用椎弓根钉系统患者发生Cage移位，移位的Cage可向椎管内突出，直接压迫硬膜囊及神经根，造成剧烈的根性疼痛、神经失用，甚至鞍区感觉麻木、尿便功能障碍、性功能障碍，多数情况需再次手术翻修[5]。作者在复习相关文献的基础上，收集了自2004-01以来本院收治的联合应用椎弓根钉系统行后路腰椎椎间融合后发生Cage移位的20例患者资料，对其移位原因进行分析。

1 对象和方法

设计：回顾性病例分析。

时间及地点：资料来源于2004-01/ 2010-01中南大学湘雅三医院。