腰椎手术失败的原因及再手术探讨  

The study on the causes and reoperative treatment of failed back surgery syndrome

作　　者：杨启远[1] 罗小丽[1] 冯敬[1] 梁文杰[1] 范斌[1] 冯志[1] 赖显金[1] 陈良[1] 

机构地区：[1]四川绵阳市第三人民医院脊柱外科,四川绵阳621000

出　　处：《颈腰痛杂志》2011年第5期372-374,共3页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的分析导致腰椎手术失败的原因,探讨再手术的方法及疗效。方法回顾分析2006-01-2010-01收治38例腰椎手术失败患者资料,所有病例均行再次手术治疗,其中经椎板间开窗或原椎板间扩大开窗切除椎间盘16例,半椎板切除减压椎间盘切除10例,全椎板切除减压椎间盘切除7例,经后路椎管减压椎弓根螺钉固定、植骨融合5例。结果全部患者随访6个月～3年,平均随访1年3个月。采用Macnab疗效评定标准,优27例,良9例,可2例,优良率94.7%。结论腰椎间盘突出症再手术的主要原因包括髓核摘除不彻底,多间隙椎间盘突出遗漏,术后椎间盘突出复发,术前及术中节段定位错误,术后出现腰椎节段性不稳以及合并神经根管狭窄,侧隐窝狭窄和中央椎管狭窄。其中以忽略侧隐窝狭窄及髓核摘除不彻底最为多数(47.3%),应引起关注。如果选择适当的手术方法,腰椎手术失败的再手术治疗可以获得满意的疗效。Objective To analyze the causes for herniation of lucmbardisc operation and explore the methods,outcomes of reoperative treatment.Methods The clilical data from 38 patients from January 2006 to January 2010 were retrospectively analyzed.All the cases were reoperated including 16 cases did laminectomy or enlarged laminectomy,10 cases did semi-laminectomy,7 cases did total laminectomy,5 cases did total laminectomy and pedicle screw fixation and bone graft fusion.Results All the cases were followed up for 6 months to 3 years with the average of 1 year and 3 months.According to the Macnab standard,the excellent and good rate was 94.7% with excellent in 27 cases,good in 9 cases,acceptable in 2 cases.Conclusion The main causes for reoperation after lumbar disc surgery include：incomplete removal of herniated nucleus pulposus,neglect of multiple intervertebral space,recurrent disc herniation,wrong intraoperative location,postoperative segmental instability and the coexisting narrow and stenosis of nerve root canal,lateral recess and central spinal canal.Among them the most causes（47.3%）are neglect of lateral recess stenosis and incomplete removal of herniated nucleus pulposus,which should cause close attention.If the methods of reoperation will be choosen suitably,statisfactory outcome can be gained for the patients.

关 键 词：腰椎手术失败综合征 原因 再手术 

分 类 号：R681.53[医药卫生—骨科学]