下腰椎手术失败的原因分析及再手术治疗

Cause for failure and reoperation of lower lumbar surgery

目的:分析下腰椎手术失败的原因,探讨再次治疗的手术方法及其疗效。方法:回顾性分析15例下腰椎首次手术失败的原因,并对再次手术疗效进行评价。结果:首次手术时,术式不当2例,减压不足2例,脊柱感染2例,脊柱失稳5例,人工髓核脱出2例,椎弓根钉松动1例,手术失败导致原有症状加重并出现马尾神经损伤症状1例。再次手术后,参考改良Macnab法进行疗效评价,优4例,良9例,可1例,差1例,疗效优良率为86.7%。结论:选择合适术式、术中彻底减压、必要时加用内固定融合术是减少下腰椎首次手术失败的有效手段,再次手术最好施行内固定融合术。

Objective： To analyze the common cause for lower lumbar surgery and to explore the effective reoperation.Methods： Clinical data of 15 cases with failed lower lumbar surgery were analyzed retrospectively.Result： Two cases failed due to wrong operative mode,2 due to deficient decompression,2 due to infection of spine,5 due to spine instability,2 due to artificial herniated nucleus pulposus,and 1 due to loosening nail in pedicle of vertebral arch.One case had original symptoms worsened and was complicated with cauda quina injury due to failed surgery.After reoperation,the modified Macnab scale showed 4 excellent cases,9 good cases,1 fair case,and 1 poor case,with the excellent and good rate as 86.7%.Conclusions： Proper operative mode,complete decompression and fusion by internal fixer if necessary are effective to lower the operative failure rate for lower lumbar surgery.Fusion by internal fixer should be used in reoperation.