| 胡勇,陈绪国,袁振山,董伟鑫,赖欧杰,孙肖阳,朱秉科,许建忠.腰椎椎间融合术后置入物后移的危险因素[J].脊柱外科杂志,2020,18(3):172-175. |
腰椎椎间融合术后置入物后移的危险因素  点此下载全文 (Fulltext) |
| 胡勇 陈绪国 袁振山 董伟鑫 赖欧杰 孙肖阳 朱秉科 许建忠 |
| 宁波大学医学院附属宁波市第六医院脊柱外科, 宁波 315040 |
| 基金项目：宁波市科技惠民项目（2016C51001） |
| DOI：10.3969/j.issn.1672-2957.2020.03.006 |
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| 摘要： |
| 目的 探讨腰椎椎间融合术后置入物后移的危险因素。方法 回顾性分析2011年10月-2016年12月接受后路腰椎椎间融合术（PLIF）或经椎间孔腰椎椎间融合术（TLIF）治疗的628例患者临床资料，以术后是否发生置入物后移将患者分为后移组（22例）和非后移组（606例）。记录所有患者术后发生置入物后移的潜在影响因素，包括性别、年龄、骨密度、手术时间、术中出血量、手术方式、融合节段、置入物类型、螺钉类型、术中是否加压、终板是否刮除、置入是否充分等，分析以上因素组间差异是否具有统计学意义，并对差异有统计学意义的因素采用logistic回归分析评价其与术后置入物后移的相关性。结果 628例患者中22例发生置入物后移，其中轻度后移12例、重度后移10例，后移发生率为3.5%。组间比较显示，螺钉类型、术中是否加压、终板是否完全刮除、置入是否充分4个方面差异有统计学意义（P<0.05）。Logistic回归分析显示上述4个指标与术后置入物后移具有相关性。结论 万向螺钉的应用、术中未加压、终板完全刮除及置入不充分是腰椎椎间融合术后出现置入物后移的危险因素，术中融合器的放置应尽量靠近椎体中央，对置入物后移合并神经功能受损者应尽早行翻修手术。 |
| 关键词：腰椎 脊柱融合术 手术后并发症 危险因素 |
| Risk factors for implant retropulsion after lumbar interbody fusion Fulltext |
| HU Yong CHEN Xu-guo YUAN Zhen-shan DONG Wei-xin LAI Ou-jie SUN Xiao-yang ZHU Bing-ke XU Jian-zhong |
| Department of Spinal Surgery, Ningbo No.6 Hospital, Medicine School of Ningbo University, Ningbo 315040, Zhejiang, China |
| Fund Project: |
| Abstract: |
| Objective To investigate the risk factors for implant retropulsion after lumbar interbody fusion. Methods The clinical data of 628 patients who received posterior lumbar interbody fusion(PLIF)/transforaminal lumbar interbody fusion(TLIF) from October 2011 to December 2016 were retrospectively reviewed. The patients were divided into 2 groups according to whether the implant retropulsion accured after treatment:22 patients in retropulsion group and 606 in non-retropulsion group. Potential factors influencing implant retropulsion were recorded in all the patients,including gender,age,bone mineral density,operation time,intraoperative blood loss,surgical methods,fusion segment,implant type,screw type,intraoperative pressuring or not,scraping of the endplate or not,sufficient implanting or not. The differences in above factors between the 2 groups were analyzed to determine whether the differences were statistically significant,and logistic regression analysis was used to evaluate the correlation between significant factors and implant retropulsion after lumbar interbody fusion. Results Among 628 cases,22 had implant retropulsion,including 12 mild retropulsion and 10 severe retropulsion. The incidence of implant retropulsion was 3.5%. The inter-group comparison showed statistically significant differences in screw type,intraoperative pressure,complete scraping of the endplate and sufficient placement of implanting(P<0.05),which were included in correlation analysis. Logistic regression analysis showed that 4 statistically significant factors were associated with implant retropulsion. Conclusion The application of universal screw,no pressure during operation,complete scraping of endplate and inadequate placement of implant are the factors influencing implant retropulsion after lumbar interbody fusion. The placement of implant should be as close as possible to the center of the vertebral body,and revision surgery should be performed as soon as possible for patients with implant retropulsion and impaired nerve function. |
| Keywords:Lumbar vertebrae Spinal fusion Postoperative complications Risk factors |
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