腰椎融合术再手术原因及其治疗

Causes and treatment methods of reoperation of lumbar spinal fusion surgery

[目的]探讨腰椎融合术再手术的原因及其治疗方法,为临床减少再手术的发生率和提高再手术疗效提供参考。[方法]回顾性分析2005年1月～2012年4月苏州大学附属第一医院收治的28例腰椎融合术后再手术患者的临床资料,其中男7例,女21例;年龄2876岁,平均58.4岁。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]早期再手术原因:椎管内血肿形成4例;腹主动脉损伤1例。晚期再手术原因:钉棒系统松动、断裂或连接棒过长7例;椎弓根螺钉进入椎管1例;植骨未融合3例;减压不彻底2例,1例合并瘢痕形成;手术方式选择不当2例;邻近节段退变7例;精神心理因素1例。再手术方式:腹主动脉修补术1例;椎管探查血肿清除术4例;内固定系统取出术4例;椎管减压、椎体间植骨融合加内固定术12例;椎管减压、后外侧植骨融合加内固定术2例;前路融合术1例;开窗髓核摘除术3例;椎管减压瘢痕切除1例。5例发生脑脊液漏,术后35d脑脊液漏愈合。随访6～63个月,平均26.7个月,X线片显示植骨均达骨性融合;未见内固定松动或断裂。Oswestry功能障碍指数由再手术前(86.7±14.1)%降至随访时(23.7±9.7)%,差别有统计学意义(P<0.05)。[结论]腰椎融合术后再手术因素复杂,仔细分析再手术原因,个体化合理选择再手术方式仍可获得较好的疗效。

[Objective] To explore the causes of reoperation of lumbar spinal fusion surgeries and their treatment strate- gies, thus to reduce the incidence of reoperation and to improve the clinical efficacy of reoperation. [ Methods] The clinical da- ta of 28 patients with reoperation of lumbar spinal fusion surgeries were analyzed retrospectively from January 2005 to April 2012. There were 7 males and 21 females with an average age of 58.4 years, ranging from 28 to 76 years. The efficacy of reopera- tion was evaluated by imageology examination and the Oswestry Disability Index （ODI） . [ Results ] The short - term causes for reoperation included spinM hematoma formation in four cases and injury of abdominal aorta in one case. The long - term cau- ses included screw -rod system loose, break or too long in seven cases, pedicle screws into the spinal canal in one case, bone grafting nonunion in three cases, uncompleted decompression in two cases and one scar formation, improper operation in two ca- ses, adjacent segment degeneration in seven cases, mental and psychological factors in one cases. The reoperation of lumbar spi- nal fusion surgeries included removal of canal hematoma in four cases, repair of abdominal aorta in one case, removal of internal fixation system in four cases, spinal canal decompression and lumbar interbody fusion with internal fixation in 12 cases, spinal canal decompression and lumbar lateral fusion with internal fixation in two cases, anterior fusion in one cases, fenestration resec- tion of nucleus pulposus in three cases, spinal canal decompression with scar removal in one case. There were five cases with ce- rebrospinal fluid leakage, and the leakage healed 3 - 5 days after surgery. The mean follow - up time was 26. 7 months, ranging from 6 to 63 months. Bone graft fusion was noted radiographically and no internal fixation loosening or breakage occurred. The ODI was （ 86. 7 ± 14. 1 ） % at reoperation and （23.7 ±9.7 ） % at follow - up （ P 〈 0. 05 ） . [ Conclusion] The causes of reop- eration of lumbar spinal fusion surgery were complex. Satisfactory results can be obtained by careful analysis of causes of reopera- tion and, individual rational selection of re - surgical methods.