腰椎间盘突出症再手术36例临床分析

Pepeated operation for lumbar prolapsed disc: clinical analysis of 36 cases

本文对３６例腰椎间盘突出症再手术病例进行了临床分析。再手术的原因为：腰椎间盘突出２４例，其中１０例合并侧隐窝狭窄，５例合并中央椎管狭窄；神经根周围粘连５例，其中１例合并中央椎管狭窄；神经根瘢痕化４例同时均合并侧隐窝狭窄；马尾神经损伤合并蛛网膜下腔粘连３例。再手术的结果：优１０例，良１５例，可８例，差３例。随访８月～８年，平均３年３个月。再手术的结果与术中的病理改变有密切关系，由椎间盘突出，骨赘等引起的神经根受压，疗效较好。而神经根瘢痕化及马尾神经损伤合并蛛网膜下腔粘连者疗效欠佳。再手术的关键在于侧隐窝部位的彻底减压。

cases with repeated operation for lumbar prolapsed disc were reported. The causes of reoperation were disc herniation in 24, amorng them 5 cases with central spinal stenosis and 10 with lateral spinal stenosis; periphiral adhesion of nerve root in 5 with central spinal stenosis in 1; scar formation of the nerve root with lateral spinal stenosis in 4; and injury of the cauda equina with adhesion of the subarachnoid space in 3. All patients were followed up for an average period of 39 months, ranging from 8 months to 8 years. The results of the reoperation were excellent in 10, good in 15, fair in 8, and poor in 3. The results were significantly related to the pathological change, nerve root compression due to recurrent disc hemiation or to bony compression. The patients responded well to repeat decompression, but sciatica due to scar formation was seldom improved by repeated operation. The key of the reoperation is the sufficient decompression of the lateral spinal.