腰椎内固定融合术后翻修原因及手术方案选择

Reasons and surgery program for revision after lumbar internal fixation and fusion

目的分析腰椎内固定融合术后翻修的原因并探讨再次手术治疗方案的选择。方法回顾性分析从2011年7月—2019年3月治疗的腰椎固定融合术后失败病人38例,对每一例病情进行详细分析,总结术后翻修的原因,并针对原因选择合理的翻修方法。通过观察翻修术前术后VAS评分、Oswestry功能障碍指数(Oswestry disability index ODI)及MacNab标准评价翻修术后疗效。结果术后随访12~48个月,平均36.8个月,翻修术后VAS评分明显改善(P<0.001)、ODI评分由翻修手术前的(88.30±12.53)%减少到末次随访(10.10±8.57)%(P<0.001),末次随访MacNab评分,优28例,良7例,可2例,差1例。结论腰椎内固定融合术后翻修的原因比较多,具体分析翻修的原因,选择合理的翻修方案,仍可以得到满意的治疗效果。因此术前应掌握脊柱内固定融合手术指证和应用原理,规范手术操作,减少翻修率。

Objective To analyze the reasons for revision after lumbar internal fixation and fusion and to explore the options of reoperation program.Methods A retrospective analysis was performed on 38 patients who failed the operation of lumbar fixation and fusion from July 2011 to March 2019.Each case was analyzed in detail,while the reasons for postoperative revision were summarized.And a reasonable revision method was selected according to the reasons.The VAS score,Oswestry Disability Index(ODI)and MacNab criteria were observed and used to evaluate the efficacy of the revision surgery.Results The postoperative follow-up period ranged from 12 to 48 months,with an average of 36.8 months.The VAS score significantly improved after revision(P<0.001).The ODI score decreased from(88.30±12.53)%before revision to(10.10±8.57)%at the last follow-up(P<0.001).In the last follow-up,the MacNab score was excellent in 28 cases,good in 7 cases,fair in 2 cases and poor in 1 case.Conclusion There are many reasons for revision after lumbar internal fixation and fusion.By analyzing the reasons for revision in detail and choosing a reasonable revision plan,satisfactory therapeutic effect can still be obtained.Therefore,the indications and application principles of lumbar internal fixation and fusion surgery should be mastered before operation to standardize surgical procedures and reduce revision rate.