腰椎滑脱症翻修手术(附21例报告)

目的探讨腰椎滑脱症初次手术失败原因、翻修手术方式及疗效。方法回顾分析2003年4月～2006年10月21例腰椎滑脱症翻修手术病例,针对初次手术失败的原因,分别应用后路椎弓根螺钉复位内固定加椎体间植骨融合术、后路椎弓根螺钉复位内固定加前路椎体间植骨融合术以及后路椎弓根螺钉复位内固定加前路游离腓骨移植椎体间植骨融合术进行再次手术,比较术后疗效、滑脱椎体复位率以及植骨融合率。结果本组全部患者翻修手术后均获随访,时间为4～48个月,平均32.6个月,总体优良率为90.48%,所有翻修手术病例植骨融合良好,植骨融合最短时间为3.8个月,最长时间为6.4个月,滑脱椎体再次复位后矫正度无丢失,椎弓根螺钉无松动及断裂。结论腰椎滑脱症初次手术失败原因主要与手术方式选择不当、忽视植骨融合的质与量以及手术操作不当有关,只要翻修手术方式得当、术中仔细操作、合理应用内固定及植骨融合材料,仍能取得满意疗效。

Revision of lumbar spondylolisthesis(A report of twenty one cases)

Objective To study the failure cause of primary lumbar spondylolisthesis operation, revision technique and therapeutical effect. Methods The failure causes of primary lumbar spondylolisthesis operations were retrospectively analysed in 21 cases from Apr. 2003 to Oct. 2006. The revision techniques included the posterior pedicle screw fixation and lumbar interbody fusion, the posterior pedicle screw fixation and anterior lumbar interbody fusion, and the posterior pedicle screw fixation and anterior lumbar interbody fusion with free fibula graft. The therapeutical effect, rate of lumbar spondylolithesis reduction and bone graft fusion were observed. Results All the cases was followed up, and the time was from 4 months to 48 months, with average time of 32.6 months. The whole excellent and good rates were 90.48 per cent. All cases with revision operations had good bone graft fusion, with the minimum fusion time 3.8 months, and maximum fusion time 6.4 months. Neither loss of spondylolisthesis reduction nor losening or breakage of pedicle screws was found. Conclusion The main failure causes of primary lumbar spondylolisthesis operation had much close relationship with the primary operative mode, the quantity and quality of bone graft and surgical manipulation. The good outcome of rivision operation could be gained by ideal revision technique, careful manipulation and rational application of internal fixation and graft material.