后路椎体间融合术后融合器脱出的原因及其翻修术.docVIP

后路椎体间融合术后融合器脱出的原因及其翻修术 后路椎体间融合术后融合器脱出的原因及 其翻修术 中国脊柱脊髓杂志2006年第l6卷第l2期ChineseJournolofineandina/c0,2006,Vo1.16,No.12909 后路椎体间融合术后融合器 脱出的原因及其翻修术 张亚峰,杨惠林,唐天驷,史勇 (苏州大学附属第一院骨科215006苏州市) 【摘要】目的:探讨后路椎体问融合术后融合器脱出的原因及其翻修方法.方法:10例后路椎体间融合术后融 合器脱出行翻修术的病例,其中腰椎滑脱症5例,腰椎管狭窄症3例,腰椎间盘突出症2例.手术节段为L4/5 4例,LJ5/S13例,L4/5+L5/S13例;融合器应用BAK(旋人型)7例,聚醚醚酮矩形融合器(PEEK)2例,钛金属 矩形融合器1例.于首次术后1,90d内行翻修术.就其脱原因,再次手术方法及疗效进行分析.结果:融合 器脱出的原因:矩形融合器中2例型号太小,1例放置位置偏后;旋人型融合器1例定位错误,其余大都因两枚 融合器之间发生碰撞挤压所致.翻修术后获得完整随访资料者8例,随访时间10,36个月,平均17个月,均得 到融合,无融合器再次移位或脱以及内同定的断裂,1例伴有足下垂者遗留患足背 弱,其余病例神 伸肌力减 经症状消除.结论:后路腰椎椎体问融合术后融合器脱出的可能原冈有融合器型号偏小导致椎间隙撑开不够, 放置位置偏后,两枚融合器不对称或距离太近发生碰撞等.早期,积极的手术翻修能取得较好的疗效. 【关键词】脊柱融合;并发症;翻修术;融合器 中图分类号:R687.3,R619文现标识码:A文章编号:1004—406X(2006)一12—0909 —04 Therevisionofthefailedposteriorlumbarin~rbodyfusion/ZHANGYafeng.YANGHuilin.TANG Tiansi.etal//ChineseJournalofSpineandSpinalCord.2006.16(12):909-912 【Abstract】 Objective:Toanalysethereasonsthatcontributetothemigrationofintertbodycagesafterposteri— orlumbarinterbodyfusionandstudytherevisionstrategies.Method:10patientswhoexperiencedthefailure ofposteriorlumbarinterbodyfusionandunderwentsurgicalcorrectionwerereviewed.2malesand8females withanaverageageof51.5yearswereincluded.Theprimaldiagnosesweredischerniationin2,lumbar spinalstenosisin3,andspondylolisthesisin5,thefusedsegmentswereL4/5in4,L5/S1in3andL4/5plus I5/S1in3.ThreekindsoffusioncagesincludingBAK,PEEKandtitaniumrectangularcagewereused.The averagelengthoftimebeforerevisionsurgerywas39days(rangefrom1to90days).Result:Thereasonsof migrationwereinadequatesizeorinsufficientdepthofinsertioninanatomiccageandthecollisionoftwo cagesinthreadedcage.Amongthosepatients,8caseswerefollowedupfrom10to36monthswithanaverage of17months,theyallgainedthesolidfusion.Nocagedisplacementorthefailureoftheinternalfixationwas observed.Alltheneurologicaldeficitswererecoveredexcept1casesufferedfrommilddroppingfoot.Conclu- sion:Thefactorsassociatedwithfailureoftheoriginalinsertionproceduremayfailtoachieveadequate