PLIF术后Cage移位的危险因素分析及相关临床处理的探讨

发布时间：2018-08-29 17:04

【摘要】：目的:探讨间融合术(PLIF)术刺笼式椎间融合器(Cage)移位的主要危险因素以及相关临床上的处理,尽可能避免PLIF术刺Cage移位的发生。方法:本研究选择诊断为腰椎间盘突出症、腰椎椎管狭窄、I度和II度腰椎滑脱在本院行间融合,X线显影的Cage植入,椎弓根钉内固定术并且获得完整随访的病例共194例。其中PLIF术刺Cage移位的病例共16例,男10例,女6例,平均年龄为56.31±7.46岁;PLIF术刺Cage未移位的病例共178例,男59例,女119例,平均年龄为52.52±11.97岁。采用SPSS16.0统计学软件分析PLIF术刺Cage移位的危险因素以及其相关程度,包括年龄、身体质量指数(BMI)、性别、置入Cage的深度、Cage与椎间隙骨性终板贴合情况、内固定松动情况、单/双侧内固定、椎间隙高度丢失情况、融合节段的数目和是否伴有糖尿病等。结合本次研究的病例情况及相关的文献资料,对PLIF术刺Cage移位的危险因素和相关临床上的处理进行分析和探讨。结果:①单因素分析结果显示:置入Cage的深度(P0.001)、Cage与椎间隙骨性终板贴合情况(P0.001)、内固定松动情况(P=0.011)、椎间隙高度丢失情况(P0.001)、性别(P=0.019)、BMI(P=0.005)等因素均可能与PLIF术刺Cage移位的发生有关。②多因素分析结果显示:置入Cage的深度不足(OR=11.212,P=0.003)、Cage与椎间隙骨性终板贴合不佳(OR=5.712,P=0.031)、椎间隙高度有丢失(OR=20.776,P=0.001)等因素均可能是PLIF术刺Cage移位的危险因素。结论:置入Cage的深度不足、Cage与椎间隙骨性终板贴合不佳、椎间隙高度有丢失均可能是PLIF术刺Cage移位发生的危险因素;内固定有松动、男性、BMI增高等因素对于PLIF术刺Cage移位发生的风险可能相对较大。
[Abstract]:Objective: to explore the main risk factors and clinical management of (Cage) transposition of cage interbody fusion cage in (PLIF) operation, and to avoid the occurrence of Cage transposition during PLIF operation as far as possible. Methods: in this study, 194 patients with lumbar disc herniation, lumbar spinal stenosis I degree and II degree lumbar spondylolisthesis were selected for Cage implantation with interline fusion X-ray, pedicle screw fixation and complete follow-up of lumbar spondylolisthesis. There were 16 cases (10 males and 6 females) with Cage transposition by PLIF. The average age was 56.31 卤7.46 years old. There were 178 cases (59 males, 119 females, mean age 52.52 卤11.97 years). SPSS16.0 statistical software was used to analyze the risk factors of Cage transposition in PLIF operation and its correlation degree, including age, body mass index (BMI),) sex, the depth of Cage insertion to the intervertebral end plate, and the loosening of internal fixation. Unilateral / bilateral internal fixation, loss of height of intervertebral space, number of fusion segments and whether diabetes was associated. The risk factors and clinical management of transposition of Cage in PLIF operation were analyzed and discussed. Results the results of one-factor analysis showed that the depth of insertion of Cage (P0.001), the attachment of age to intervertebral space osteogenic endplate (P0.001), the loosening of internal fixation (P0. 011), the loss of height of intervertebral space (P0. 001), sex (P0. 019) and BMI (P0. 005) may all be associated with the occurrence of transposition of Cage in PLIF. The results of multivariate analysis showed that OR=11.212,P=0.003, OR=5.712,P=0.031 and OR=20.776,P=0.001 might be the risk factors of Cage transposition after PLIF operation. The risk factors of Cage transposition were as follows: (1) low depth (OR=11.212,P=0.003) and OR=5.712,P=0.031 (intervertebral space end plate), and (2) loss of intervertebral space height (OR=20.776,P=0.001) were the risk factors for Cage transposition during PLIF operation. Conclusion: the depth of Cage implantation is not good with the osseous endplate of intervertebral space, and the loss of intervertebral space height may be the risk factor for the transposition of Cage in PLIF operation, and the internal fixation is loosened. The risk of transposition of Cage during PLIF may be higher in men.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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