腰椎间盘突出症再手术的原因分析及治疗

Analysis of reasons for reoperation of recurrence of herniated intervertebral disk and the strategy

目的 :探讨腰椎间盘突出症再手术原因及治疗策略。方法 :通过对 2 9例腰椎间盘突出症初次手术未能缓解症状而再次手术的原因进行分析 ,并行再次手术治疗 ,随访 1～ 5年 ,平均 3 4个月 ,优良率为 86 2 %。结果 :初次手术效果不佳的原因为 :定位错误、髓核残留过多、多间隙突出、神经根通道减压不彻底、瘢痕压迫等。结论 :术前仔细体格检查和影像学检查 ,术中认真操作、减压彻底 ,术后合理的功能锻炼是避免腰椎间盘突出症手术效果不佳的重要因素。

Objective To analysis and to evaluate causes of recurrence of herniated intervertebral disk for providing strategy of its reoperation. Methods Analysis and evaluate the causes of 29 cases recurrence of herniated intervertebral disc from 1998 to 2003. According to those causes of each case, take another operation of it. Results Err locacion or leakage another protrusive position, leave more pulpse tissue in the disc space, the scar tissue adhesion and compression and uncompletely decompression of the never root cause first operation failed mainly. 29 cases were followed up from 1year to 5 years and the mean period was 34 months. The excellent good rate reached 86.2%. Conclusion Carefully physical examination and make a sustemical analysis of the imaging manifestations to accurate the location before taking a prorate operation; carefully operation, avoided injury the nerve root during dissection, resection of the scar tissue adhesion and decompression completely are the key to increase the curative effect.