腰椎滑脱术后失败病例后路再手术的疗效

Posterior revision surgery for failed lumbar spondylolisthesis

中文关键词:  腰椎  脊柱滑脱  再手术  脊柱后路手术

英文关键词:Lumbar vertebra  Spondylolishesis  Revision surgery  Posterior spinal surgery

中文摘要:

  【摘要】 目的：探讨个体化腰椎后入路手术治疗腰椎滑脱术后失败病例的疗效。方法：回顾分析2004年1月至2007年11月再手术治疗的12例腰椎滑脱术后失败病例的临床资料，单纯腰椎不稳2例，单纯腰椎管狭窄1例，腰椎不稳伴腰椎管狭窄4例，腰椎间盘突出1例，明显植骨未融合4例；内置物失败包括椎弓根内固定松动5例，椎弓根螺钉断裂3例（其中2例合并椎间融合器突入椎管），单纯椎间融合器突入椎管1例。再手术时采用双侧椎弓根螺钉系统内固定加双侧cage椎体间植骨融合术5例，双侧椎弓根螺钉系统内固定加单枚cage椎体间植骨融合术3例，单侧椎弓根螺钉系统内固定加单侧cage椎体间植骨融合术2例，单纯椎板间开窗减压术1例，另1例更换cage椎体间融合，而保留原有的椎弓根内固定系统。对所有患者进行定期随访，通过影像学检查与Oswestry功能障碍指数综合评价再手术的疗效。结果：所有患者均顺利完成手术，术中1例硬膜囊撕裂，术后发生脑脊液漏，经抬高床脚，术后5d脑脊液漏愈合，无脊髓神经损伤等严重并发症发生。随访1.5～4年，平均2.7年。椎间植骨均达骨性融合，椎间融合器无移位；未见椎弓根螺钉固定系统松动或断裂；腰椎滑脱无加重或复发。Oswestry功能障碍指数末次随访时为21.9%±3.0%，与术前81.8%±2.5%比较，差异有统计学意义（P<0.05）。结论：腰椎滑脱术后失败因素复杂，应根据具体病因个体化选择手术方法，后路手术是治疗这类疾病的有效方法之一。

英文摘要:

  【Abstract】 Objective：To explore the clinical efficacy of individualized posterior revision surgery for failed lumbar spondylolisthesis.Method：The clinical data of 12 patients experiencing failed surgery due to lumbar spondylolisthesis were reviewed retrospectively from January 2004 to October 2007. 2 cases suffered from lumbar instability，1 case from lumbar spinal stenosis，4 cases from combined lumbar instability and stenosis，1 case from intervertebral disc herniation and 4 cases from bone graft nonunion.Instrument failure included screw loosening in 5 cases and screw broken in 3 cases，of 3 cases with screw broken，2 cases were complicated with perforation of cages into spinal canal，1 case had perforation of cages into spinal canal alone.Revision surgical procedures included pedicle screw plus bilateral cages implantation in 5 cases，pedicle screw plus unilateral cages implantation in 3 cases，unilateral pedicle screw plus unilateral cages implantation in 2 cases，single laminectomy and discectomy in 1 case，cage reimplantation while leaving pedicle screw intact in 1 case.All cases were followed up routinely.Radiography and Oswestry Disability Index（ODI） were used to evaluate the outcome of revision surgery.Result：All cases underwent revision surgery successfully with no neuroinjury noted.Only one case was complicated with cerebrospinal fluid leakage which was resolved 5 days later.The mean follow-up time was 2.7 years（range，1.5 to 4 years）.Bone graft union was evidenced in all cases without cages displacement，instrument failure and lumbar spondylolisthesis recurrence.The ODI was 81.8%±2.5% and 21.9%±3.0% for preoperation and follow-up respectively，which showed statistical significance between them（P<0.05）.Conclusion：Due to its complexity with regarding to failed lumbar spondylolisthesis，individualized posterior surgical protocols should be taken.Posterior spinal re-operation is one of effective procedure for failed lumbar spondylolisthesis.