多裂肌间隙入路手术治疗腰椎手术失败综合征

目的探讨利用自行研制的一套腰椎微创手术器械,以多裂肌肌间隙入路直视下微创经椎间孔腰椎椎体融合术在腰椎翻修手术中的临床疗效。方法选择我院2010年11月至2011年11月收治的腰椎手术失败综合征行直视下微创腰椎翻修手术的患者12例进行回顾性分析,其中腰椎间盘突出症行单纯性椎板开窗减压髓核摘除术后6例,腰椎间盘突出伴腰椎不稳、腰椎滑脱行后路腰椎椎体融合术后4例,腰椎管狭窄后路椎板开窗减压术后2例;术前已进行一次手术的9例,二次手术的2例,三次手术的1例。本组共融合17节段,L4～54例,L5S13例,L4～5和L5S1双节段2例,L3～4和L4～5双节段3例;通过影像学资料和末次随访的临床表现进行改良Macnab标准疗效评定。结果所有病例均获得随访,随访时间6～18个月,平均(13±3.9)个月;依据改良Macnab标准进行疗效评定,12例中,优9例,良3例,可0例,差0例,优良率100%(12/12)。结论多裂肌肌间隙入路治疗腰椎手术失败综合征,降低了手术风险,减少了术后并发症。

Muitifidus Gap Approach for Surgical Treatment of Lumbar Spine Surgery Failure Syndrome

Objective To investigate the use of a self-developed minimal invasive surgical instruments and the clinical efficacy in the lumbar spine revision surgery under direct vision minimally invasive transformational lumbar vertebral body fusion （TLIF） with a multifidus muscle gap approach. Methods From Nov. 2010 to Nov. 2011 12case of failed back surgery syndrome（FBSS）were admitted to our hosipital and accepted minimally invasive lumbar revision surgery under direct vision. There were 6 cases of lumbar disc herniation with simple laminectomy decompression and discectomy,4 cases of lumbar disc herniation with lumbar instability,and spondylolisthesis by posterior lumbar inter- body fusion, 2cases of lumbar spinal canal narrow with posterior laminectomy decompression surgery. Among the 12 cases,There were 9 cases of second surgery,2 cases of third surgery, 1 cases of fourth surgery. There were a total of 17 segments,including 4 cases of L4-s, 3 cases of L5 ~S1,2 cases of double-segment L4-5 ,L5~S1 and 3cases of double- segment L3-4,L4-5. Modified Macnab criteria was used to assessed the clinical effect according to the clinical manifes- tations of the last follow-ups and the image data. Results All patients were followed up for 6~ 18 months,with an average of （13±3. 9） months. According to the efficacy evaluation of the modified Macnab criteria,among the 12cases, 9 cases were excellent, 3 cases good, 0 cases fair and 0 cases popr,excellence rate 100 % （12/12）. Conclusion Treatment of lumbar spine surgery failure syndrome through the multifidus muscle gap approach can reduce the risk of surgery and the postoperative complications.