摘要
目的探讨腰椎滑脱手术失败翻修手术的疗效。方法回顾性分析1997至2004年收治的43例采用椎管减压、器械复位内固定治疗腰椎滑脱的翻修手术及术后随访情况。男26例，女17例；年龄23-65岁，平均46．5岁。所有43例患者均因首次手术后症状复发或加重而再次入院，首次手术的术式为：单纯内固定（未进行减压、植骨）14例，减压、植骨及内固定术29例。翻修手术的原因包括：滑脱节段仍不稳定10例，滑脱加重11例，内固定物松动或断裂20例，手术节段错误2例，植骨不融合1例，假关节形成2例。所有患者均采用翻修手术治疗。对所有病例进行定期随访和影像学检查。结果翻修手术治疗后，对所有患者进行了平均18．5个月的随访，手术总优良率86．1％，无术后感染并发症。19例横突间植骨及24例椎间植骨者均达到骨性融合。未见到内固定物再松动或断裂，滑脱无复发。翻修术后患者原有症状基本缓解，肢体功能恢复良好。结论单纯椎板切除减压或间盘切除术不适合于腰椎滑脱症患者，减压不够彻底、内固定松动或断裂、椎间未植骨或植骨不融合是导致内固定失败或滑脱加重的主要原因。翻修时彻底减压，椎间及后外侧植骨，复位内固定，手术的规范性操作及术后指导患者合理的腰部运动等是预防手术失败的关键。
Objective To evaluate the clinical outcome of revision lumbar spondylolisthesis surgery, a retrospective study was conducted. Methods From 1997 to 2004, 43 cases with failed spondylolisthesis surgery were treated with revision procedures of decompression, instrumentation and posteriolateral fusion. There were 26 males and 17 females with an average age of 46.5 years, ranging from 23 to 65 years. The clinical results of l year postoperative were evaluated. All of these patients had recurrence or progression of back and leg pain. The causes of failure were post-operative destabilization （10 cases）; progressive spondylolisthesis （11 cases） implants failure （20 cases） and wrong segment （2 cases）. All of patients were re-operated by means of three different procedures. A prospective, observational study of the clinical outcomes and radiological data was assessed in a series of 46 patients. Results All cases were followed-up from 6-39 months after revision, 18.5 months in average. The excellent or good result was 86.1% and no infections occurred and other major complications occurred. Incorporation of graft was found in 19 cases with fusion by inter-transprocess and 24 cases by intervertebral space. No implant failure was found and all patients achieved solid fusion. Clinical result from revision was promising, but varied among different patients. Conclusion Simple laminectomy or discectomy was not indication for lumbar spondylolisthesis. Deficient decompression, the internal fixation failure, no bone graft or nonunion was the main causes of implant failure. The completely decompression and intervertebral and posterolateral bone grafting, secure internal fixation and operative technique and proper instruction of patients for postoperative recovery are the keys for the success of revision surgery.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第1期49-53,共5页
Chinese Journal of Orthopaedics
关键词
腰椎
脊柱滑脱
治疗失败
再手术
Lumbar vertebrae
Spondylolysis
Treatment failure
Reoperation
作者简介
肖睿现调入四川省宜宾市第一人民医院骨科工作
