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題名 | Clinical Outcomes of Revision Lumbar Spinal Surgery: 124 Patients with a Minimum of Two Years of Follow-up=腰椎再次手術追蹤二年以上之臨床結果 |
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作者 | 黃澤波; 陳文哲; 陳力輝; 牛自健; 賴伯亮; Wong, Chak-bor; Chen, Wen-jer; Chen, Lih-huei; Niu, Chi-chien; Lai, Po-liang; |
期刊 | 長庚醫學 |
出版日期 | 20020300 |
卷期 | 25:3 2002.03[民91.03] |
頁次 | 頁175-182 |
分類號 | 416.61 |
語文 | eng |
關鍵詞 | 脊椎手術失敗症候群; 脊椎融合術; 再次手術; Failed back surgery syndrome; Spinal fusion; Revision surgery; |
中文摘要 | 背景: 文獻報告腰椎再次手術之成功率由12%至82%不等。探討造成手術成功之因素並沒有一致共識,本篇追蹤124位病患接受腰椎再次手術之臨床結果及探討那些因素和預後有關。 方法: 從1992年至1996年,共124位病患接受腰椎再次手術及追蹤24至89個月,平均37.6個月。我們從病患接受門診追蹤檢查,問卷調查及X光片影像判讀,了解病患術後狀況。分析不同因素和臨床結果之關係,如:年齡、性別、術前診斷、主術前手術次數、疼痛解除期、神經功能缺損、手術方式及腰椎融合情形。 結果: 腰椎再次手術之成功率達83.9%。施行腰椎融合術及成功之腰椎融合與成功之結果有統計數據上的相關。腰椎不穩定之病患接受腰椎再次手術比腰椎狹窄之病患有較好之結果。腰椎再次手術之併發症達9.6%,嚴重之併發症會影響術後結果。 結果: 對於要達到成功的腰痽再次手術,必須了解及解決腰椎手術失敗的原因,才能達到滿意的結果。若腰椎不穩定,建議同時施行脊椎融合手術及達到成功的腰椎融合。 |
英文摘要 | Background: Pertinent literature on revision lumbar spinal surgery has revealed a wide variation in success rates, ranging from 12% to 82%. In addition, a solid consensus has not yet been reached on its positive factors. We retrospectively reviewed 124 consecutive patients who underwent revision lumbar spinal surgery and investingated the factors that affected the outcomes of their surgery. Methods: Revision lumbar spinal surgery was performed in 124 patients from January 1992 to December 1996, with an average follow-up of 37.6 months (range, 24-89 months). The various factors analyzed included age, gender, previous diagnosis, number of previous operations, period of pain-free interval, neurologic deficit, operative procedure, and fusion status. This analysis revealed the effect of each factor on the overall results. Radiographs were obtained, and patients were assessed during the final follow-up or by questionnaire. Results: The success rate of revision lumbar spine surgery in this study was 83.9%. Successful outcomes were significantly associated with the spinal procedure with fusion and with union of the spinal fusion. Patients with defined mechanical instability had better results than did those with stenosis only. In addition, the complication rate for repeated lumbar spinal surgery was 9.6% and major complications attributed to poor results. Conclusion: This study reveals a high success rate of revision spinal surgery. We recommend performing spinal fusion, and achievement of solid fusion in repeated low back surgery is invaluable for patients with spinal instability. Targeting the specific pathology of failed back surgery syndrome is crucial in attaining satisfactory results with revision lumbar spinal surgery. |
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