Objective To investigate the relative factors of Cage after posterior lumbar interbody fusion and +Cage fusion in patients with degenerative lumbar disease.Methods From September 2009 to March 2014,there were 241 cases with lumbar degenerative diseases,including 56 cases of lumbar disc herniation,129 cases of lumbar spinal stenosis,56 cases of lumbar spondylolisthesis;48 cases with degenerative lumbar scoliosis.241 cases were 282 segments for interbody fusion surgery,surgical segment distribution:2 cases of L1-2 segment,L2-3 3 cases,L3-4 6 cases,L4-5 130 cases,L5-S1 31 cases,L3-4 and L4-5 in 33 cases,9 cases of L4-5 with L5-S1,the other in 26 cases.All patients were followed up for 24 months,3 days,1,3,6 months and 2 years after surgery,the clinical efficacy was observed,including main outcome measures:(1)the VAS score,Oswestry disability index;(2) Cobb angle,anterior and posterior segment surgery intervertebral height before and after the operation,before and after the vertebral margin of intervertebral height changes.At the same time,the Cage placement,integration,etc were recorded.Results In 241 cases,a total of 8 cases of Cage occurred after theshift,including kidney shaped cuboid 2 pieces,3 pieces,3 pieces and the bullet,but did not appear to dura or nerve root,and 3 months after the operation had successful fusion,so no revision surgery.8 patients with preoperative vertebral anterior and posterior height was significantly higher than the control group,and the Cage height and intervertebral height ratio was significantly lower than the control group (P＜0.05).Single factor analysis showed that Cage insertion depth insufficiency,shape angle Cage,complicated with lumbar degenerative scoliosis patients and straight endplate,the incidence of Cage after the shift was significantly higher (P＜0.05),suggested that these risk factors may increase after Cage shift.Conclusion In posterior lumbar interbody fusion,we should combine with preoperative anterior and posterior intervertebral space height to select the appropriate type of Cage,insertion depth should be 3 mm or more,at the same time Cage slip should be avoided caused by loose of internal fixation.%目的 探讨腰椎退行性疾病行后路椎间植骨+Cage融合术后,发生Cage后移的相关因素.方法 自2009-09-2014-03,共收治241例腰椎退行性疾病患者,其中腰椎间盘突出症56例,腰椎管狭窄症129例,腰椎滑脱症56例;合并退行性腰椎侧凸48例.241例共282个节段行椎间植骨融合手术,手术节段分布情况:L1-2节段2例,L2-3例,L3-46例,L4-5 130例,L5-S1 31例,L3-4合并L4-533例,L4-5合并L5-S19例,其他26例.所有患者术后均随访24个月以上,分别于术后3天、1、3、6个月和术后2年进行疗效观察,主要观察指标包括:(1)VAS评分,Oswestry功能障碍指数;(2)Cobb角,手术节段前缘和后缘椎间隙高度,手术前后的椎体前后缘椎间隙高度变化情况.同时统计Cage置入情况、融合情况等.结果241例术后,共8例发生Cage后移,包括肾形3枚,子弹头形5枚,但并未出现压迫硬膜或神经根等情况,且术后3个月均顺利融合,故未予翻修手术.8例患者的术前椎间隙前、后缘高度均明显高于对照组,且Cage高度与椎间隙高度比值明显低于对照组(P＜0.05);单因素分析中,Cage置入深度不足、形状无角度的Cage、合并腰椎退行性侧凸的患者以及直线型终板者,其Cage后移的发生率明显更高(P＜0.05),提示上述因素可能会增加Cage后移的危险.结论在行腰椎后路椎间植骨融合术中,应充分结合术前椎间隙前、后缘高度情况选取合适型号的Cage,置入深度应在3mm以上,同时应避免内固定不牢固所引起的Cage滑移问题.
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