[1]王润生 钟睿 梁柱 王继 杨嘉 徐敏 覃智斌 黄承军△.腰椎手术失败综合征中西医结合治疗回顾研究[J].中国中医骨伤科杂志,2020,28(12):7-11.
　WANG Runsheng ZHONG Rui LIANG Zhu WANG Ji YANG JiaXU Min QIN Zhibin HUANG Chenjun.Retrospective Study of Combined Traditional Chinese andWestern Medicine to Treat Failure Back Surgery Syndrome[J].Chinese Journal of Traditional Medical Traumatology & Orthopedics,2020,28(12):7-11.
点击复制

腰椎手术失败综合征中西医结合治疗回顾研究()
分享到：

《中国中医骨伤科杂志》[ISSN:1005-0205/CN:42-1340/R]

卷:
第28卷
期数:
2020年12期
页码:
7-11
栏目:
临床研究
出版日期:
2020-12-15

文章信息/Info

Title:
Retrospective Study of Combined Traditional Chinese andWestern Medicine to Treat Failure Back Surgery Syndrome
文章编号:
1005-0205(2020)12-0007-05
作者:
王润生1 钟睿2 梁柱1 王继1 杨嘉1 徐敏1 覃智斌1 黄承军1△
1广西中医药大学第三附属医院(广西 柳州,545001)2成都体育学院附属体育医院△通信作者 E-mail:run708@163.com
Author(s):
WANG Runsheng1 ZHONG Rui2 LIANG Zhu1 WANG Ji1 YANG Jia1XU Min1 QIN Zhibin1 HUANG Chenjun1△
1The Third Affiliated Hospital of Guangxi University of Traditional Chinese Medicine,Liuzhou 545001,Guangxi China; 2 The Sport Hospital of Chengdu Sport Institute,Chengdu 610041,China.
关键词:
腰椎手术失败综合征;  经椎间孔针刀;  根性疼痛;  阶梯治疗;  中西医结合
Keywords:
failure back surgery syndrome;  needle-knife through intervertebral foramen;  radicular pain;  step treatment;  combine traditional Chinese and western medicine
分类号:
R681.5
文献标志码:
A
摘要:
目的:总结以根性症状为主要临床表现的腰椎手术失败综合征的病因及中西医结合治疗的临床疗效。方法:回顾分析2012年1月至2019年6月以根性症状为主的腰椎手术失败综合征病例78例,按照手术方式的不同分为非融合组(38例)和融合组(40例)。根据住院病历及影像学资料分析两类手术方式术后失败的病因及治疗方案差异,根据疼痛视觉模拟评分(VAS)、下腰椎Oswestry功能障碍指数(ODI)评分评价临床疗效,治疗后定期随访,随访8～14个月(平均12个月)。比较治疗前与末次随访临床疗效的差异。结果:纳入病例中男32例,女46例,平均年龄50.6岁。非融合手术38例中腰椎椎板间开窗2例,腰椎间盘镜下髓核摘除(MED)术后10例,椎间孔镜下髓核摘除术后26例。融合手术40例中后路腰椎椎间融合术(PLIF)手术10例,经椎间孔腰椎椎间融合术(TLIF)术后6例,微创经椎间孔腰椎椎间融合术(MISTLIF)术后24例。所有病例术后均出现典型根性症状,其中非融合组髓核残留10例,术中神经根损伤8例,侧隐窝减压不彻底3例,术后椎间盘突出复发6例,神经根粘连11例。融合组病因包括椎弓根螺钉误置8例,Cage后退4例,椎间孔狭窄5例,神经根损伤6例,神经根粘连8例,内固定失效5例,邻近节段退变4例。所有病例均具有典型根性症状,表现为神经根支配区域放射痛、麻木,肌力下降、腱反射减弱等。非融合组治疗前VAS评分(4.9±2.8)分,ODI评分(82.5±11.2)分; 融合组治疗前VAS评分(5.5±2.3)分,ODI评分(76.5±14.3)分,两组VAS及ODI评分差异无统计学意义(P>0.05)。结合患者病情,采用保守治疗、神经根阻滞联合经椎间孔针刀松解、翻修手术三个阶梯进行治疗,融合组末次随访VAS评分(1.8±0.8)分,ODI评分(25.8±6.0)分,非融合组末次随访VAS评分(2.0±0.9)分,ODI评分(21.0±6.8)分,两组VAS及ODI评分差异无统计学意义(P>0.05)。结论:具有典型根性症状的腰椎手术失败综合征病因复杂,根据不同病因采用中西医结合阶梯治疗方案可获得良好的临床疗效。
Abstract:
To study the etiology of failure back surgery syndrome(FBSS)with typical radicular pain and the treatment efficacy of integrated Chinese and western medicine.Methods:78 cases of FBSS with typical radicular pain from January 2012 to June 2019 were analyzed retrospectively.They were divided into non-fusion group(38 cases)and fusion group(40 cases).The etiology and treatment options of the two groups were analyzed by hospitalized medical records and images.The clinical curative effect was evaluated by visual analogue scale(VAS)and low back Oswestry disability index(ODI).All cases were followed 8～14 months(12 months on average).The clinical curative effect before and after treatment were documented and compared.Results:There were 32 male and 46 female with 50.6 years old on average in this study.There were 38 cases in non-fusion group.Among them,2 cases underwent laminectomy,10 cases underwent micro-endoscopic discectomy(MED)and 26 cases underwent percutaneous endoscopic lumbar discectomy(PELD).There were 40 cases in fusion group,10 cases underwent lumbar interbody fusion(PLIF),6 cases underwent transforaminal lumbar interbody fusion(TLIF)and 24 cases underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF).All cases complained of radicular pain,in the non-fusion group,10 cases were caused by residues of nucleus pulposus,8 cases by injury of nerve root in operation,3 cases by incomplete decompression of lateral recess,6 cases by recurrence of disc herniation,11 cases by peridural scar.In the fusion group,8 cases were caused by pedicle screw misplacement,4 cases by displacement of cages,5 cases by lumbar foraminal stenosis,6 cases by injury of nerve root in operation,8 cases by peridural scar,5 cases by failure of internal fixation,4 cases by adjacent segment degeneration(ASD).All cases complained radicular pain,numbness,muscle weakness and decline of tendon reflex.Before treatment there were(4.9±2.8)in VAS and(82.5±11.2)in ODI score of non-fusion group,and(5.5±2.3)in VAS and(76.5±14.3)in ODI score of fusion group.There was no statistical significance between the two groups(P>0.05).Conservative treatment including nerve root block combined needle-knife through intervertebral foramen and revision surgery at the end were performed.The VAS was(1.8±0.8)and ODI score was(25.8±6.0)in fusion group,and the VAS was(2.0±0.9)and ODI score was(21.0±6.8)in non-fusion group at the end of follow-up.The statistical difference was insignificant.Conclusion:The etiology of FBSS with radicular pain was complicated,while it was effective to treat it by step methods with combined traditional Chinese and western medicine.

参考文献/References:

[1] 董健,李超.腰椎手术失败综合征[J].中华骨科杂志,2012,32(10):984-989.
[2] 寇兴华,梁锋,马长跃.19例腰椎手术失败医疗纠纷案的探讨[J].医学与法学,2018,10(4):83-85.
[3] CHEN C W,PENG P.Failed back surgery syndrome[J].Pain Medicine(Malden Mass),2011,12(4):577-606.
[4] 尹承慧,符臣学,徐皓,等.腰椎术后综合征的原因探析和处理[J].中国脊柱脊髓杂志,2006,16(1):23-25.
[5] DANIELL J R,OSTI O L.Failed back surgery syndrome:a review article[J].Asian Spine Journal,2018,12(2):372-379.
[6] 张德辉,李运芝,张智慧,等.椎间孔镜治疗有典型根性症状的腰椎手术失败综合征[J].中国微创外科杂志,2014,14(7):647-649.
[7] ARTS M P,KOLS N I,ONDERWATER S M,et al.Clinical outcome of instrumented fusion for the treatment of failed back surgery syndrome:a case series of 100 patients[J].Acta Neurochirurgica,2012,154(7):1213-1217.
[8] SEBAALY A,LAHOUD M J,RIZKALLAH M,et al.Etiology,evaluation,and treatment of failed back surgery syndrome[J].Asian Spine Journal,2018,12(3):574-585.
[9] 马海强,王进强,刘涛.经皮椎间孔镜治疗肥胖患者腰椎间盘突出症35例[J].中国中医骨伤科杂志,2019,27(12):66-68.
[10] LIU J M,DENG H L,CHEN X Y,et al.Risk factors for surgical site infection after posterior lumbar spinal surgery[J].Spine(Phila Pa 1976),2018,43(10):732-737.
[11] 王勇,李杨健.从多例骨科腰腿疼痛的典型误诊病例探讨全科医学的临床思维[J].中国全科医学,2015,18(32):3994-3996.
[12] 张宇轩,王洪立,马晓生,等.斜外侧腰椎椎间融合术并发症的研究进展[J].中华骨科杂志,2019,39(19):1222-1227.
[13] STAARTJES V E,WISPELAERE M P D,MIEDEMA J,et al.Recurrent lumbar disc herniation after tubular microdiscectomy:analysis of learning curve progression[J].World Neurosurgery,2017,107:28-34.
[14] SCHOFFERMAN J,REYNODS J,RICHARD H,et al.Failed back surgery:etiology and diagnostic evaluation[J].The Spine Journal,2003,3(5):400-403.
[15] HONG X,LIU L,BAO J,et al.Characterization and risk factor analysis for reoperation after microendoscopic diskectomy[J].Orthopedics,2015,38(6):e490-e496.
[16] LEVEN D,PASSIAS P G,ERRICO T J,et al.Risk factors for reoperation in patients treated surgically for intervertebral disc herniation:a subanalysis of eight-year SPORT data[J].The Journal of Bone and Joint Surgery:American volume,2015,97(16):1316-1325.
[17] ROSS J S,ROBERTSON J T,FREDERICKSON R C A,et al.Association between peridural scar and recurrent radicular pain after lumbar discectomy:magnetic resonance evaluation[J].Neurosurg,1996,38(4):855-863.
[18] 梁冬波,李剑锋,王力平.腰椎间盘突出症患者腰臀部压敏点与磁共振影像学表现的相关性研究[J].中国中医骨伤科杂志,2018,26(4):45-49.
[19] WADDELL G.Evaluation of results in lumbar spine surgery:clinical outcome measures-assessment of severity[J].Acta Orthopaedica,1993,64(Sup 251):134-137.(收稿日期:2020-05-20)

备注/Memo

备注/Memo:
基金项目:广西自然科学基金青年基金(2018GXNSFBA050066)广西壮族自治区卫生厅中医药科技专项面上重大项目(GZKZ-Z1106)
更新日期/Last Update: 2020-12-15