腰椎术后综合征的原因探析和处理

Analysis of reason and management for failed back surgery syndrome

目的:探讨腰椎术后综合征(FBSS)的原因及处理方法。方法:对23例FBSS患者进行回顾性研究,综合分析患者的病史、体征、影像学表现以及术中探查结果等资料,并制订相应的治疗方案。20例影像学检查有硬脊膜和神经根受压患者予以再次手术,行硬膜囊和神经根减压以及自体骨植骨融合,其中12例应用椎弓根钉系统固定,术后予以一定康复锻炼。2例无影像学改变且症状较轻的患者予以口服消炎镇痛药辅以理疗;1例术后MRI显示椎间盘炎的患者静脉使用抗生素。结果:导致FBSS的主要原因包括神经压迫、腰椎不稳、神经损伤、椎间盘炎等。治疗效果参照Ashraf的评估标准进行综合评估,20例行手术治疗患者效果优12例,良5例,可2例,差1例。3例未手术患者,治疗效果良1例,可1例,差1例。结论:FBSS是多种原因多表现的综合征,应当综合分析患者的临床表现,针对原因,对不同的患者制定个性化的治疗方案。

Objective：To investigate the cause and the management of failed back surgery syndrome（FBSS）. Method：23 FBSS cases were investigated retrospectively.The data about the history,physical sign,image and exploration were analyzed to probe into the causes,and then,treatment protocols were made correspondingly.In all cases,20 cases who had positive image manifestation were operated with decompression of nerve root and dura assisted with fusion of auto-bone graft between posterior arches of vertebra, 12 cases were treated with pedicle screw fixation supplementarily.All patients were rehabilitated after operation.2 cases who had negative image manifestation took medicine of nonsteroidal antiinflammatory drug（NSAID） assisted with physical therapy.1 case who suffered from discitis administrated antibiotic through venoclysis.Result：The causes of FBSS included nerve compression,spinal instability,neuropathic injury,and so on.The clinical outcome measure included the presence and severity of back and leg pain,the level of postoperative activity,and the need for pain control medications. The satisfactory rate was 78.3% after individual treatment.Condusion：FBSS is a complication of back surgery manifesting as a syndrome with multi-factor and multi-presentation.Orthopaedics surgeon should analyze the clinical presentation of patient integratively to find out the cause and manage the patient individually.