摘要
目的 探讨腰椎滑脱症手术失败的原因、再手术的术式选择及疗效。方法 对 2 0例腰椎滑脱症再手术病例进行回顾性分析。所有 2 0例患者均因首次手术后症状复发或加重而再次入院 ,症状复发或加重的原因包括 ,滑脱节段仍不稳定 6例 ,滑脱加重 3例 ,内固定物松动或断裂 10例 ,手术节段错误 1例。再入院距首次手术的时间平均 2 4 3个月。所有患者均做了再次手术治疗。结果 再次手术后 ,对所有患者进行了平均 34 1个月的随访 ,手术总优良率 85 %。 18例横突间植骨及 2例椎间植骨者均达到骨性融合。 8例同时做椎间融合器植入者 ,其中 6例椎间可见骨桥形成。未再见到内固定物松动或断裂。结论 单纯椎板切除减压或间盘切除不适合于腰椎滑脱症患者 ,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。对于首次手术为前路椎间植骨或单纯间盘切除者 ,再次手术可行椎板切除减压 ,后外侧植骨及复位内固定 ;对于首次已行广泛椎板切除术者 。
Objective To study the causes of failure following surgical treatment of lumbar spondylolithesis,procedures for redo surgery and the final result of reoperation. Methods 20 patients who had a repeat operation for lumbar spondylolithesis were studied retrospectively.On average 24.3 months following the previous surgery,all of these patients had recurrence or progression of back and leg pain.All of 20 patients were reoperated by means of three different procedures. Results The causes of failure were post-operative destabilization (6 cases); progressive spondylolithesis (3 cases) implants failure (10 cases) and mistake segment (one case).After reoperation,a mean 34.1 months′ follow-up was made.The excellent or good rate was 90%.Incorporation of graft was found in 18 cases with fusion by intertransprocess and 2 cases by intervertebral space.New bone formation was found in 6 out of 8 cases that had a simultaneous intervertebral cage implant.No implant failure was found in all patients. Conclusions Simple laminectomy or discectomy was not indication for lumbar spondylolithesis.No bone graft or ununion was the main causes of implant failure.Posterior instrumented fusion with laminectomy decompression can be used in the patients who had a prior surgery of simple discectomy or anterior intervertebral bone graft.Except for posterior instrumented fusion with extensive laminectomy decompression,Intervertebral fusion should be considered in the patients who had a prior surgery of laminectomy decompression with instrument,anterior intervertebral fusion (ALIF) was recommended for these cases.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2004年第12期716-719,共4页
Chinese Journal of Surgery
