腰椎滑脱症翻修术的策略与体会

Technique and strategies of posterior lumbar interbody fusion for failed back surgery syndrome spondylolisthesis

目的针对腰椎滑脱症的再手术治疗,总结出手术技巧,提出治疗策略。方法收集2008年1月至2012年5月25例腰椎滑脱症手术失败患者,其中男性16例,女性9例;年龄28～78岁,平均52.6岁。9例采用后路减压、椎体复位、椎间植骨结合后外侧环形植骨,再用RF-Ⅱ系统加压内固定术;16例采用后路(少数病例结合前路)充分减压、椎体复位、BAK椎间融合器植入、立体植骨、RF-Ⅱ系统(少数病例采用其他系统)加压内固定术。结果全部病例术后按计划成功随访,总优良率为92.0%,腰椎滑脱大部分基本复位,临床症状明显缓解或消失,无严重并发症。结论在充分减压的基础上予椎体复位、BAK椎间融合器植入、立体植骨、RF-Ⅱ系统加压内固定治疗腰椎滑脱手术失败患者,技术规范、成熟,并发症少,实用、高效。

Objective To investigate technique and strategies of reoperation for failed back surgery syndrome. Methods From January 2008 to May 2012, 25 patients with failed back surgery syndrome were treated with reoperation. There were 16 males and 9 females with an average age of 52.6 years, ranging from 28 to 78 years. Nine patiens were treated with posterior decompression, vertebrae reduction, interbody bone grafting combined with solid bone grafting and RF- II compression internal fixation surgery. Sixteen patients were treated with ample posterior decompression （some of cases were treat with anterior decompression）, vertebrae reduction, BAK interbody fusion cage implantation, solid bone grafting and RF- II （A minority of cases were used other system） compression internal fixation surgery. Results All the patients were followed up. The excellent curative ratio was 92.0%. Most lumbar spondylolysis were found with fundamental reduction. The clinical symptoms were completely relieved and disappeared. There was no serious complication. Conclusion Failed back surgery syndrome should be treated with vertebrae reduction on the basis of ample decompression, BAK interbody fusion implantation, solid bone grafting and RF- II compression internal fixation surgery, which is a treatment of technique specification and maturity with less complication, practicality and effectiveness.