摘要
目的：观察腰椎手术失败综合征（failedbacksurgerysyndrome，FBSS）的康复治疗效果并分析其发生的原因。方法2007年10月至2014年5月，北京积水潭医院和北京市西城区展览路医院收治的FBSS患者46例，男32例，女14例，年龄25～62岁，平均44.6岁。均经脊柱外科医师排除再次手术指征，根据患者症状的不同，采用个体化、综合性康复治疗方案。采用下腰痛评分系统（ japanese orthopedic association， JOA ）评分标准对患者治疗前后的下腰痛进行评分，并计算改善率；中华医学会脊柱外科学组制订的标准对患者的治疗前症状（腰痛和下肢疼痛）、腰椎活动度、直腿抬高试验、神经功能（运动功能和感觉功能）进行评价；弱链测试评估腰椎稳定性。根据术前、后及康复治疗前、后情况分析发生FBSS的原因。结果治疗过程中没有出现疼痛加重下肢运动感觉功能障碍加重等情况。经康复治疗，JOA评分由治疗前（12.8±3.9）分提高到治疗结束时（21.7±4.6）分（ P＜0.05），临床改善率为54.9%；优22例，良18例；弱链测试，治疗前阳性的40例中，治疗结束时26例阳性结果消失、10例改善、4例无变化。FBSS且无需再次手术治疗者的致病原因有4类：手术指征选择不当；手术中操作失误；术后康复措施不当；手术相关因素，在术后逐渐演变导致病情进展。结论使用悬吊运动训练为主的个体化、综合性康复治疗FBSS患者，能明显减轻患者下腰痛，改善其腰椎活动度、直腿抬高度及神经功能，稳定腰椎。FBSS发的主要原因有手术指征选择不当；手术中操作失误；术后康复措施不当；手术相关因素，在术后逐渐演变导致病情进展。
Objective To investigate the main causes and rehabilitation effects of failed back surgery syndrome （ FBSS ）.Methods From October 2007 to May 2014, 46 patients with FBSS were treated in Beijing Jishuitan Hospital and Beijing Zhanlanlu Hospital in Xicheng District. There were 32 males and 14 females, whose average age was 44.6 years old （ range： 25-62 years ）. Spine surgeons ruled out the indications of reoperation. According to the etiological factors, an individualized and comprehensive rehabilitation therapy was applied. The Japanese Orthopedic Association （ JOA ） score was used to assess low back pain before and after the treatment, and the improvement rate was calculated. The standards set by the spine surgery group of Chinese Medical Association were used to evaluate the symptoms before the treatment （ low back pain and lower limb pain ）, lumbar range of motion （ ROM ）, straight leg raising test, nerve function （ motor and sensory functions ）. Lumbar spinal stability was assessed in the weak chain test.Results After rehabilitation treatment, the JOA score was increased from （ 12.8±3.9 ） points before the treatment to （ 21.7±4.6 ） points （P〈0.05 ）, and the clinical improvement rate was 54.9%. There were 22 excellent cases and 18 good cases. In the weak chain test, 40 patients were found to be positive before the treatment. And at the end of the treatment, the positive results disappeared in 26 patients, were improved in 10 patients and did not change in 4 patients. The causes in the patients with FBSS who did not need a revisional operation could be divided into 4 types, including improper selection of surgical indications, errors in surgical procedures, improper postoperative rehabilitation measures and operation-related factors that gradually led to disease progression.Conclusions It is very important to actively and reasonably apply the individualized and comprehensive rehabilitation therapy in the treatment of the patients with FBSS. For the patients with FBSS that is mainly caused by lumbar segmental instability, satisfactory effects can be achieved when the individualized and comprehensive rehabilitation therapy is adopted with the sling exercise therapy predominated. The cause of lumbar diseases is complex. Therefore, different treatment methods should be carefully chosen depending on the different etiological factors, so as to reduce the occurrence of FBSS.
出处
《中国骨与关节杂志》
CAS
2014年第9期670-674,共5页
Chinese Journal of Bone and Joint
关键词
腰椎手术失败综合征
康复
病因辨证
治疗结果
Failed back surgery syndrome
Rehabilitation
Syndrome differ pathogen fact
Treatment outcome
