摘要
目的:总结以根性症状为主要临床表现的腰椎手术失败综合征的病因及中西医结合治疗的临床疗效。方法:回顾分析2012年1月至2019年6月以根性症状为主的腰椎手术失败综合征病例78例,按照手术方式的不同分为非融合组(38例)和融合组(40例)。根据住院病历及影像学资料分析两类手术方式术后失败的病因及治疗方案差异,根据疼痛视觉模拟评分(VAS)、下腰椎Oswestry功能障碍指数(ODI)评分评价临床疗效,治疗后定期随访,随访8~14个月(平均12个月)。比较治疗前与末次随访临床疗效的差异。结果:纳入病例中男32例,女46例,平均年龄50.6岁。非融合手术38例中腰椎椎板间开窗2例,腰椎间盘镜下髓核摘除(MED)术后10例,椎间孔镜下髓核摘除术后26例。融合手术40例中后路腰椎椎间融合术(PLIF)手术10例,经椎间孔腰椎椎间融合术(TLIF)术后6例,微创经椎间孔腰椎椎间融合术(MISTLIF)术后24例。所有病例术后均出现典型根性症状,其中非融合组髓核残留10例,术中神经根损伤8例,侧隐窝减压不彻底3例,术后椎间盘突出复发6例,神经根粘连11例。融合组病因包括椎弓根螺钉误置8例,Cage后退4例,椎间孔狭窄5例,神经根损伤6例,神经根粘连8例,内固定失效5例,邻近节段退变4例。所有病例均具有典型根性症状,表现为神经根支配区域放射痛、麻木,肌力下降、腱反射减弱等。非融合组治疗前VAS评分(4.9±2.8)分,ODI评分(82.5±11.2)分;融合组治疗前VAS评分(5.5±2.3)分,ODI评分(76.5±14.3)分,两组VAS及ODI评分差异无统计学意义(P>0.05)。结合患者病情,采用保守治疗、神经根阻滞联合经椎间孔针刀松解、翻修手术三个阶梯进行治疗,融合组末次随访VAS评分(1.8±0.8)分,ODI评分(25.8±6.0)分,非融合组末次随访VAS评分(2.0±0.9)分,ODI评分(21.0±6.8)分,两组VAS及ODI评分差异无统计学意义(P>0.05)。结论:具有典型根性症状的腰椎手术失
Objective:To study the etiology of failure back surgery syndrome(FBSS) with typical radicular pain and the treatment efficacy of integrated Chinese and western medicine.Methods:78 cases of FBSS with typical radicular pain from January 2012 to June 2019 were analyzed retrospectively.They were divided into non-fusion group(38 cases) and fusion group(40 cases).The etiology and treatment options of the two groups were analyzed by hospitalized medical records and images.The clinical curative effect was evaluated by visual analogue scale(VAS) and low back Oswestry disability index(ODI).All cases were followed 8~14 months(12 months on average).The clinical curative effect before and after treatment were documented and compared.Results:There were 32 male and 46 female with 50.6 years old on average in this study.There were 38 cases in non-fusion group.Among them,2 cases underwent laminectomy,10 cases underwent micro-endoscopic discectomy(MED) and 26 cases underwent percutaneous endoscopic lumbar discectomy(PELD).There were 40 cases in fusion group,10 cases underwent lumbar interbody fusion(PLIF),6 cases underwent transforaminal lumbar interbody fusion(TLIF) and 24 cases underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF).All cases complained of radicular pain,in the non-fusion group,10 cases were caused by residues of nucleus pulposus,8 cases by injury of nerve root in operation,3 cases by incomplete decompression of lateral recess,6 cases by recurrence of disc herniation,11 cases by peridural scar.In the fusion group,8 cases were caused by pedicle screw misplacement,4 cases by displacement of cages,5 cases by lumbar foraminal stenosis,6 cases by injury of nerve root in operation,8 cases by peridural scar,5 cases by failure of internal fixation,4 cases by adjacent segment degeneration(ASD).All cases complained radicular pain,numbness,muscle weakness and decline of tendon reflex.Before treatment there were(4.9±2.8) in VAS and(82.5±11.2) in ODI score of non-fusion group,and(5.5±2.3) in VAS and(7
作者
王润生
钟睿
梁柱
王继
杨嘉
徐敏
覃智斌
黄承军
WANG Runsheng;ZHONG Rui;LIANG Zhu;WANG Ji;YANG Jia;XU Min;QIN Zhibin;HUANG Chenjun(The Third Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Liuzhou 545001,Guangxi China;The Sport Hospital of Chengdu Sport Institute,Chengdu 610041,China)
出处
《中国中医骨伤科杂志》
CAS
2020年第12期7-11,共5页
Chinese Journal of Traditional Medical Traumatology & Orthopedics
基金
广西自然科学基金青年基金(2018GXNSFBA050066)
广西壮族自治区卫生厅中医药科技专项面上重大项目(GZKZ-Z1106)。
关键词
腰椎手术失败综合征
经椎间孔针刀
根性疼痛
阶梯治疗
中西医结合
failure back surgery syndrome
needle-knife through intervertebral foramen
radicular pain
step treatment
combine traditional Chinese and western medicine
