复发性腰椎间盘突出症两种手术方式对比分析

Contrast analysis of 2 kinds of operative treatment for recurrent lumbar disc herniation:a report of 24 cases

[目的]分析复发性腰椎间盘突出症的病理机制及探讨椎间融合器后路椎间融合内固定治疗的理论依据及优缺点。[方法]将24例有明显腰椎不稳表现的复发性腰椎间盘突出症患者分为内固定组(14例)和非内固定组(10例),分别采用椎间融合器后路椎间融合内固定治疗和重复的髓核摘除术治疗,对临床资料进行总结。[结果]2组病例均获6个月以上,平均18个月的随访,内固定组14例无机械不稳引起的并发症如椎体滑脱,无椎间融合器后退及下沉,无螺钉断裂及松动;根据MacNab疗效评定标准,优良率92.8%。非内固定组10例腰椎不稳仍存在或加重,3例发生腰椎滑脱;根据MacNab疗效评定标准,优良率60%。[结论]复发性腰椎间盘突出症病理机制主要是腰椎不稳,椎间融合器后路椎间融合内固定治疗符合生物力学要求,疗效确切。

[Objective] To analyze the pathomechanism of recurrent lumbar disc herniation and to find out the theoretical basis, the advantage and disadvantage of the treatment of posterior lumbar interbody fusion （PLIF） with cage combined with internal fixation. [ Method ] 24 cases of recurrent lumbar disc herniation with obvious unsteadiness of lumbar vertebrae were divided into 2 groups： internal fixation group （ 14 cases） and non-internal fixation group （ 10 cases）. The 2 groups were treated with PLIF with cage combined with internal fixation and repeated discectomy respectively. The clinical data was summarized. [ Result] All cases got a long-term follow-up more than 6 months. In the internal fixation group, no complication of mechanical unsteadiness such as spondylolisthesis occurred, no cage moved and no screw broke or got loose. The satisfactory rate was 92. 8% based on MacNab criteria. In the non-internal fixation group, the unsteadiness of lumbar vertebrae remained or even deteriorated： lumbar spondylolisthesis occurred in 3 cases. And the satisfactory rate was 60% based on MacNab criteria. [ Conclusion] The unsteadiness of lumbar vertebrae is the main pathomechanism of recurrent lumbar disc herniation. The treatment of PLIF with cage combined with internal fixation for recurrent lumbar disc herniation accords with biomechanical demand and the curative effect is satisfactory.