单节段PLIF术后融合器后移的危险因素分析

Analysis of the Risk Factors of Cage Retropulsion after Single Segment PLIF

摘要: 目的：通过回顾性研究单节段PLIF (Posterior Lumbar Interbody Fusion, PLIF)术后Cage (腰椎融合器)后移的发生原因和有关因素的关系，进一步分析和阐述相关风险因素。方法：通过收集大理大学第一附属医院脊柱外科自2019年1月至2021年8月，共32个月，进行单节段PLIF的手术患者203例共203个椎间隙，术后出现Cage后移9例，位移时间1~16个月，平均8个月。通过分析比较患者术后腰椎融合器发生后移的病例数据资料。结合患者自身因素，手术操作等相关因素采用SPSS25.0的t检验或卡方检验等进行分析，检验其和Cage发生后移的关系，对于有关联的危险因素进一步用logistic回归明确其意义。结果：在203例病例资料中，Cage后移9例(4.4%)，统计学分析显示：1) 骨质疏松 (P < 0.01)；2) 椎间隙形状(P = 0.015)；3) Cage和终板贴合程度(P = 0.01)有统计学意义。而年龄、性别、BMI和Cage后移没有明确的统计学意义。结论：骨质疏松、椎间隙形状、Cage和终板贴合程度可能是单节段PLIF术后发生Cage后移的相对独立危险因素，对于术前合并此类疾病患者应充分做好术前评估或选用大一号Cage等预防Cage后移的发生。

Abstract: Objective: To conduct a retrospective study on the causes and related factors of postoperative Cage displacement in single segment PLIF (posterior lumbar interbody fusion Cage fusion), and further analyze and elucidate the relevant risk factors. Method: A total of 203 patients with 203 interver-tebral spaces underwent single-segment PLIF surgery from January 2019 to August 2021 in the Spinal Surgery Department of the First Affiliated Hospital of Dali University. Nine patients experi-enced postoperative displacement, with a displacement time of 1~16 months and an average of 8 months. By analyzing and comparing case data of postoperative lumbar fusion Cage displacement in patients, combining the patient’s own factors, surgical procedures, and other related factors, SPSS 25.0 t-tests or chi square tests were used to analyze the relationship between them and the occur-rence of Cage displacement. For associated risk factors, logistic regression was further used to clari-fy their significance. Result: Among the 203 case data, 9 cases (4.4%) had a posterior displacement of Cage. Statistical analysis showed: 1. Osteoporosis (P < 0.01); 2. Shape of intervertebral space (P = 0.015); 3. There was statistical significance in the degree of fit between the Cage and the endplate (P = 0.01). However, there was no clear statistical significance for age, gender, BMI, and age shift. Con-clusion: Osteoporosis, intervertebral space shape, degree of Cage and endplate fit may be relatively independent risk factors for postoperative Cage displacement in single segment PLIF. For patients with preoperative complications of this disease, preoperative evaluation or selection of larger Cage should be fully done to prevent Cage displacement.