240例腰椎手术失败综合征的回顾性分析

Retrospectively Analysis of 240 Cases of Failed Back Surgery Syndrome

目的对腰椎手术失败综合征(failed back surgery syndrome,FBSS)的原因、之前的手术方式进行分析。方法回顾性分析2003年1月至2013年12月我院骨科收治的240例腰椎手术失败综合征患者的临床资料,依据诊断的不同分为三组,组1为182例腰椎间盘突出症术后;组2为31例腰椎管狭窄症术后;组3为27例腰椎滑脱症术后。收集的临床资料包括性别、年龄、术后症状复发时间、之前的手术方式和手术节段、入院诊断。总结分析FBSS的原因及其和之前的手术方式的关系。结果患者共240例,男136例,女104例。三组原因比例最高的分别是:腰椎间盘突出复发、腰椎管狭窄、内固定失败。三组之前的手术中比例最高的术式分别是:单纯髓核摘除术、椎板切除减压术、腰椎后路侧方植骨融合内固定术。结论腰椎手术失败综合征的原因复杂,包括腰椎间盘突出复发、腰椎管狭窄、手术并发症、相邻节段退变性疾病、内固定失败等,而合理运用手术方式或可减少腰椎手术失败综合征的发生。

Objective To analyze the cause and the method of primary operation of failed back surgery syndrome（ FBSS）. Methods Patients with failed back surgery syndrome during January 2003 to December 2013 in the Department of orthopedic surgery of my Hospital were retrospectively enrolled. According to the different primary diagnosis before the primary operation,patients were divided into three groups. Group one received 182 patients whose primary diagnosis are lumbar disc herniation. Group two received 31 patients whose primary diagnosis are lumbar spinal stenosis. Group three received 27 patients whose primary diagnosis are lumbar spondylolisthesis. We reviewed all patients＇ medical records,including sex,age,course of the recurrent symptom,the method of primary operation,the location of the first surgical segment and diagnosis. We analyzed the causes of FBSS and the relationship with method of primary operation. Results 240 were enrolled in this study including136 males and 104 females. The the most frequent causes of three groups were recurrent lumbar disc herniation,lumbar spinal stenosis and instrumentation failure,respectively. The most failed methods of primary operation of three groups were fenestration laminectomy and discectomy,laminectomy,internal fixation and posteriolateral fusion,respectively. Conclusion The causes of FBSS are complex,including recurrent lumbar disc herniation accounting,lumbar spinal stenosis,complications,adjacent segment disease,the failure of instrumentation. Using right surgical method may can reduce the incidence of FBSS.