前外侧入路腰椎融合术发生融合器早期沉降的相关因素

Factors Associated with Cage Early Subsidence in Oblique Lumbar Interbody Fusion

摘要: 目的：研究前外侧入路腰椎融合术(oblique lumbar interbody fusion, OLIF)术后发生融合器早期沉降的相关因素。方法：选择2020年4月至2024年4月在青岛市市立医院行前外侧入路腰椎融合术联合后路椎弓根螺钉内固定治疗腰椎退行性疾病的患者共137例为研究对象，统计一般资料，完成术前、术后3天内和随访(>6个月)的标准正侧位X线片，测量相关影像学参数。采用单因素分析及二元Logistic回归法分析融合器沉降的相关危险因素。结果：与未发生早期沉降的患者相比，发生早期沉降的患者Ward’s三角骨密度更低，术后椎间高度(前缘、均值)、椎间高度差值、随访椎间高度均值，融合器高–术后椎间高度更小。相较于早期发生Grade I型沉降的患者，发生Grade II型沉降的患者腰椎前凸角更大。结论：术前完善检查，合理制定手术方案有助于降低OLIF术后发生早期融合器沉降的概率。

Abstract: Objective: To explore the risk factors associated with cage early subsidence after oblique lumbar interbody fusion (OLIF) surgery. Methods: A total of 137 patients who underwent OLIF combined with posterior lumbar instrumentation for lumbar degenerative diseases at Qingdao Municipal Hospital between April 2020 and April 2024 were selected as the study subjects. General demographic data were collected, and standard anteroposterior and lateral X-rays were obtained preoperatively, within 3 days postoperatively, and during follow-up (>6 months). Relevant radiographic parameters were measured and analyzed. Univariate analysis and binary logistic regression were used to identify the relevant risk factors associated with cage subsidence. Results: Compared with patients who did not experience early subsidence, patients with early subsidence had lower bone mineral density in Ward’s triangle, smaller postoperative intervertebral height (anterior edge, mean value), smaller intervertebral height difference, smaller mean value of follow-up intervertebral height, and smaller cage height-postoperative intervertebral height. Compared with patients with early Grade I subsidence, patients with Grade II subsidence had a larger lumbar lordosis angle. Conclusion: Completing preoperative examinations and formulating reasonable surgical plans can help reduce the probability of early cage subsidence after OLIF.