脊柱再手术22例初步研究

[目的]分析脊柱手术再次手术的原因及方式选择相关因素.[方法]从2008年1月～2010年12月,共收治因椎间盘突出症、椎体压缩性骨折、脊柱不稳症及多间隙椎管狭窄症等行脊柱手术(椎间盘摘除术、经皮椎间盘切吸术、髓核摘除+椎间植骨融合椎弓根钉系统内固定术等)治疗的患者134例,根据不同原因,需行相应再手术者17例,再手术率12.7％.同期在外院行腰椎内固定术后而在本院再手术者5例.[结果]22例患者中男17例,女5例；年龄40～85岁(平均64.21岁),其中椎间盘摘除术后脊柱不稳者5例,经皮椎间盘切吸术后症状改善不明显或术后加重者4例,椎管成形术术后症状改善不明显4例,椎弓根螺钉系统术后感染者3例,椎间植骨融合椎弓根钉系统内固定术术后神经根受压2例,椎板开窗减压椎弓根内固定术后症状未见明显缓解2例,椎间植骨融合内固定术后内固定松动2例.22例再手术患者随访至今(8～41个月),90％的患者对手术结果满意,按照改良MacNab标准,优良率86.4％.[结论]严格掌握手术适应证、术中规范操作、术后指导患者合理的脊柱康复运动等是减少再手术的有效途径,再手术只要处理得当,术后仍可获得较好的疗效.

Preliminary study of spinal reoperation in 22 cases

[Objective]To analyze the reasons and therapeutic effects for revision of spinal surgery.[Methods]From January 2008 to December 2010,134 patients underwent spinal operation for disc herniation,compression spinal fracture,unstable fracture,multi-level spinal stenosis in our hospital,17 patients needed revision operation with revision rate of 12.7% among these cases.At the same time,5 patients who were operation in other hospitals were reoperated by authors.[Results]Among these 22 cases,17 patients were males,5 case were females,whose age were 40-85 years(average 63.30 years).The reasons for reoperation included spinal instability after discectomy(5 cases),no obvious symptoms improved or increased after percutaneous cervical discectomy(4 cases),symptoms improve was not obvious after spinal posterior laminoplasty(4 cases),infection after spine pedicle screw fixation system was in 3 cases,misplacement of pedicle screws was in 2 cases,symptoms were not significant after laminectomy decompression(2 cases),loosening of pedicle screw fixation was in 2 cases.Mean follow-up ranged 8~41 months.90% of the patients were satisfactory to the results of reoperation,the rate of success was 86.4% according to modified MacNab criteria.[Conclusion]The effective ways to reduce lumbar spinal revision surgery include appropriate patients inclusion or exclusion criteria,standardized operation skill,proper insertion of implants and rehabilitation.Reoperations may achieve a good therapeutic result if it is performed appropriately.