CAJ | 학술논문

目的：回顾性分析腰椎内固定翻修手术的临床疗效。方法2009年1月至2012年12月我科共收治腰椎后路内固定术后需行翻修患者36例，其中男20例，女16例，年龄45~68岁，根据影像学检查结果结合患者临床特点采用不同翻修手术。结果36例患者均顺利完成手术。内固定取出12例；调整椎弓根螺钉及Cage位置4例；更换钉棒系统+植骨融合12例；椎管探查神经根减压及椎间植骨融合7例；手术清创，置管冲洗引流1例。术中发现椎弓根螺钉松动使用骨水泥强化置钉2例，发生脑脊液漏4例；术后伤口表浅感染、延迟愈合1例；深部感染局部形成窦道1例，通过抗菌、换药治疗治愈。获得随访34例，随访时间24~38个月，平均为26．8个月。无钉棒松动，融合率100%，平均融合时间术后6个月。腰腿疼痛JOA评分术前(12．0±1．6)分，末次随访时恢复到平均(24．2±2．3)分，神经功能改善率74%。结论腰椎内固定术后翻修手术难度大，合理的翻修手术，能够获得良好的临床疗效。腰椎管造影有助于明确神经损害的部位和范围，减少探查的盲目性。
목적：회고성분석요추내고정번수수술적림상료효。방법2009년1월지2012년12월아과공수치요추후로내고정술후수행번수환자36례，기중남20례，녀16례，년령45~68세，근거영상학검사결과결합환자림상특점채용불동번수수술。결과36례환자균순리완성수술。내고정취출12례；조정추궁근라정급Cage위치4례；경환정봉계통+식골융합12례；추관탐사신경근감압급추간식골융합7례；수술청창，치관충세인류1례。술중발현추궁근라정송동사용골수니강화치정2례，발생뇌척액루4례；술후상구표천감염、연지유합1례；심부감염국부형성두도1례，통과항균、환약치료치유。획득수방34례，수방시간24~38개월，평균위26．8개월。무정봉송동，융합솔100%，평균융합시간술후6개월。요퇴동통JOA평분술전(12．0±1．6)분，말차수방시회복도평균(24．2±2．3)분，신경공능개선솔74%。결론요추내고정술후번수수술난도대，합리적번수수술，능구획득량호적림상료효。요추관조영유조우명학신경손해적부위화범위，감소탐사적맹목성。
Objective To investigate the clinical effect of revision surgery after lumbar spinal canal decompression and internal fixation. Methods To gather and analysis 36 patient underwent revision surgery after lumbar spinal canal decompression and internal fixation from 2009 to 2012 in our hospital,in which there are 20 cases are male and16 cases are female. The age of these cases is from 45 to 68 years old. Different revision surgery was completed according to the patients with symptoms and signs and imaging findings. Results The revision surgery was performed in 36 patients ,include pure internal fixation was removed in 12 cases;pedicle screws and Cage was adjusted in 4 cases;Replace the internal fixation and bone graft fusion in 12 cases;decom-pression and bone graft fusion was performed in 7 cases;internal fixation removed and drainage in 1 case. Postoperative cerebrospi-nal fluid leakage occurred in 4 cases, superficial wound infection in 1 case, deep infection and local fistula formed in 1 case. 34 patients were abtained followed up of an average of 26. 8 months. According to JOA scoring criteria,neurological function score was (12. 0 ± 1. 6)preoperative and(24. 2 ± 2. 3)at final follow up,the amelioration of nerve function was 74%. Conclusion The re-vision surgery is difficult after lumbar spinal canal decompression and internal fixation. If reasonable revision surgery was comple-ted,good clinical effect can obtain. Myelography have important reference value to find the location and extent of nerve damage, which reduce the blindness of revision surgery and maximum benefit for patients.