腰椎间盘突出症再手术的原因及对策

The Reasons of Re-operation of LDH and Surgical Treatment

目的 分析腰椎间盘突出症再手术的原因 ,评价预防性神经根通道扩大的作用。方法 自 1975年～ 2 0 0 1年共对 5 6例腰椎间盘突出症患者进行了再手术治疗。术中摘除髓核 ,对存在神经根通道狭窄者 ,扩大神经根通道 ,使神经根充分游离 ;对无明显神经根受压者 ,用薄斜口冲击咬骨钳紧贴内侧壁潜行咬除侧隐窝壁及上关节突内侧半 ,扩大神经根通道的储备空间。对存在椎间不稳同时行椎间融合 ,BAK植入术。结果 经平均 5 1年随访 ,按改良Macnab疗效评定标准 ,优良 5 1例 ,可 2例 ,差 3例 ,优良率 91 1%。结论 再手术的主要原因是同间隙复发及病变节段神经根通道狭窄。再次手术治疗 ,在尽量摘除髓核的同时 ,预防性神经根通道扩大可以有效提高腰椎间盘突出症再次手术的远期疗效 ,对于椎间不稳可同时行椎间融合术。

Objective To understand the reasons of re-operation of LDH,and to evaluate the effect of preventive expanding lateral recess on reoperation of LDH.Methods Fifty five patients (average 40.5 years old) of LDH were underwent reoperative managements from 1975 to 2001. Nerve root channels were expanded to relieve the roots when lateral recessus were stenosis, medial wall of lateral recessus were removed just medial to it with thin kerrison punch when lateral recessus were stenosis. Interbody fusion and implantation of BAK were performed in 4 cases for instability.Results All patients were followed-up for 5.1 years averagely. The results were excellent and good in 51 cases, moderate in 2 cases and worse in 3 cases by Macnab's standard.The excellent and good rate was 91.1%.Conclusion The reasons of re-operation is recurrence and lateral recessus stenosis. Preventive expanding laterl recessus may improve the result of re-operation of LDH in long term results obviously, at the same time of excising nucleus as much as possible. Interbody fusion may performed at the same time when there is instability.