下腰椎手术失败综合征的有限化手术治疗

目的：探讨与下腰椎手术失败综合征（ＦＢＳＳ）有限化手术相关的定位定性诊断及手术操作方法，减少手术失败率及致残率。方法：术前定位定性诊断采用ＣＴＥ、ＣＴＭ与数字图像处理技术相结合，清楚了解硬膜囊受压及粘连的程度和范围。手术采用原手术部位的侧方入路有限化操作技术，不扩大减压范围去除瘢痕组织及神经根受压的诸多因素，重建上下关节突，恢复椎管侧后方的屏障及生物力学功能。结果：３０例ＦＢＳＳ患者手术治疗１～５年随访，优良率９０％。结论：有限化手术兼顾到了神经根的彻底松解及上下关节突的生物力学功能，使手术的创伤降低到最小，再次手术的成功率明显提高，有推广应用价值。

The Minimal Surgery Treatment of Failed Back Surgery Syndrome

Objective: The localization diagnosis and the limited surgical technique of the Failed Back Surgery Syndrome(FBSS) were studied to reduce the rates of surgical failure and maim.Methods:　The localization diagnosis of preoperative CTE and CTM combined with the method of digital imaging processing were used.The degree and extent of the compression and adhesion of theca sac were clearly observed.The limited operative procedure through the lateral posterior route at site of the original incision was used and the scar tissue and the other elements of nerve root compression were removed without enlargement of decompression extent so that the superior and inferior articular processes were re constructed and the lateral posterior protective screen and biomechanical effects were restored. Results: The excellent and good results of ninety percent in the 30 cases of FBSS operated on were found with follow-up period from one to five years. Conclusion: Both the adequate decompression of nerve root and the maintainance of biomechanical function of articular facet joints may be achieved and the surgical trauma can be decreased to the minimum by the limited procedure so that the succeed rates of repeat operation greatly increase. The procedure poses a practical value of popularization.