目的 探讨腰椎管狭窄术后再手术的常见原因, 寻求再手术时术中和术后的应对措施。方法 回顾性分析我科收治的21例腰椎管狭窄症再手术患者的临床资料。全部患者均经过先期后路减压手术, 部分经过后路内固定, 由于症状不缓解或再次出现症状而采取后路再手术, 分析再手术的原因、术后疗效和相关的手术操作过程。结果 本组再手术的原因主要包括：减压不彻底、腰椎不稳、螺钉位置偏差、椎间盘突出术后复发、术式选择欠妥等, 再手术前JOA评分为11.28±2.67, 再手术后的患者均得到随访和定期复查, 随访时间12~36个月, 平均24.8个月, 随访终末JOA评分及改善率为（19.45±2.79）%和（45.34±7.87）%, 术后下肢感觉、肌力和功能障碍得到明显恢复。结论 严格掌握手术适应证, 有效的减压, 合理的内固定, 可以使再手术的患者获得较好的疗效。

Objective To study the reasons of revision operation for lumbar spinal canal stenosis and the operative and post-operative procedures. Methods Twenty-one patients with lumbar spinal canal stenosis were recruited. All patients underwent primary decompression operation and several with internal fixation by posterior approach. Revision operations were performed because symptoms remained. The reason, effect and relative process of these operations were analyzed. Results The main reasons in our revision operative group included incomplete decompression, instablility of lumbar vertebrae, deflection of screws, postoperative recurrence of lumbar disc herniation and improper operative type. All patients were followed up for a period of 12-36 months (24.8 months on average) and reviewed regularly after operation. Before revision surgery, the lumbar JOA score was 11.28?2.67, but at final follow-up, the lumbar JOA score was 19.45?2.79. The improvement rate was (45.34?7.87) %. The sensation, muscle strength and function of lower limbs were satisfactory. Conclusions Good effect can be obtained through strict control of indications of operation, effective decompression and reasonable fixation.