【摘要】 目的：探索骨质疏松症患者后路腰椎融合术后融合器（cage）下沉的危险因素。方法：本研究前瞻性纳入2021年1月至2021年12月因腰椎退行性疾病接受后路腰椎椎间融合术的骨质疏松症患者59例，随访至少6个月。收集患者一般资料、最低T值、L1椎体CT值、椎间融合节段、cage高度、术后6个月cage下沉率和植骨融合率。本研究骨质疏松诊断标准为T值≤-2.5或L1椎体CT值≤110 HU,L1椎体CT值≤80 HU记为重度骨质疏松。术后即刻X线中cage下沉>2 mm定义为终板损伤。术后6个月下沉>2 mm记为下沉，下沉>4 mm记为重度下沉。腰椎X线检查提示无椎间不稳且腰椎CT提示融合节段终板间连续植骨块形成记为融合。结果：术后6个月，以患者统计，cage下沉率71.2%(42/59)，重度下沉率37.3%(22/59)。重度下沉组与非重度下沉组相比，L1椎体CT值更低[（80.6±23.3）HU vs.(94.0±24.8)HU,P=0.044]，其他指标差异无统计学意义。共90个椎间融合节段，以融合节段统计，重度下沉节段的cage高度更大[（12.2±2.0）mm vs.(10.2±1.8)mm,P<0.001],CT值更低[（78.7±24.4）HU vs.(95.0±23.8)HU,P=0.006]。17.8%(16/90)的节段存在终板损伤。终板损伤节段的重度下沉率高于无损伤节段（81.3%vs. 13.5%,P<0.001）。Logistic回归分析提示终板损伤、cage高度≥12 mm、重度骨质疏松症（L1椎体CT值≤80 HU）是cage重度下沉的独立危险因素。结论：骨质疏松症患者行后路椎间融合术时要注意保护终板，避免使用高度过大的融合器。对于L1椎体CT值≤80 HU的重度骨质疏松症患者，要谨慎选择椎间融合术，注意抗骨质疏松治疗。更多还原

【Abstract】 Objective: To explore the risk factors for cage subsidence after posterior lumbar interbody fusion in osteoporotic patients.Methods: A total of 59 osteoporotic patients undergoing posterior lumbar interbody fusion for lumbar degenerative diseases from January 2021 to December 2021 were prospectively studied. The minimal follow-up was 6 months. This study collected the general information, the lowest T-score, L1 vertebral CT value, the level of interbody fusion, cage height and etc. The criteria for diagnosing osteoporosis was the lowest T-score≤-2.5 or L1-CT value≤110 HU, the patients with L1-CT value≤80 HU was diagnosed as severe osteoporosis. The endplate injury was defined as cage subsidence>2 mm in immediate postoperative X-ray. At 6-month follow-up, cage subsidence was defined as a displacement of cages by>2 mm into the endplates. Cage subsidence>4 mm was defined as severe subsidence. The successful fusion status was defined as continuous fusion mass across the endplates without segmental instability.Results: At 6-months follow-up, the cage subsidence rate(counted in patients) was 71.2%(42/59), and severe subsidence rate was37.3%(22/59). The general information was comparable between the subsidence group and non-subsidence group. The severe subsidence group showed lower L1-CT value than non-severe subsidence group([80.6±23.3] HU vs. [94.0±24.8] HU, P=0.044), and the other indexes were comparable between the two groups. There were 90 levels of interbody fusion. The severe subsidence levels showed higher cage height([12.2±2.0] mm vs. [10.2±1.8] mm, P<0.001) and lower CT value([78.7±24.4] HU vs. [95.0±23.8] HU, P=0.006) than the non-severe subsidence levels. The endplate injury rate was 17.8%(16/90). The endplate injury group showed higher subsidence rate than the non-injury group(81.3% vs. 13.5%, P<0.001). The logistic regression analysis indicated that the endplate injury, cage height≥12 mm, severe osteoporosis(L1-CT value≤80 HU) were the independent risk factors for severe subsidence.Conclusions: The surgeons should pay attention to the protection of endplate, and do not choose oversize fusion cage when performing fusion procedures for osteoporotic patients. As for the patients with severe osteoporosis(L1-CT value≤80 HU), we should be prudent to choose interbody fusion, and offer anti-osteoporosis treatment.更多还原