复发性腰椎间盘突出症再手术的临床研究

The clinical experience on the reopertiopn for recurrent lumbar disks herniation after discectomy

目的探讨椎管彻底减压、后路cage椎间融合、椎弓根系统内固定的治疗复发性腰椎间盘突出症的效果。方法对20例采用上述方法治疗的复发性腰椎间盘突出症患者进行回顾性分析。根据术前及术后随访时JOA评分（15分法）、术后患者主观满意度分级及影像学结果评价手术效果，并分析其并发症。结果20例平均手术时间（162±2．4）min，平均出血量（640±5．6）ml。平均随访8个月，手术前后JOA评分有差异显著（P≤0．05），JOA评分临床改善率为79.05％；患者主观满意度优良率为86.25％；骨折融合率为95％。并发症包括4例硬膜撕裂；一过性单例神经根麻痹、假关节形成各1例。结论椎管彻底减压、后路cage椎间融合、椎弓根系统内固定治疗复法性腰椎间盘突出症效果满意，无严重并发症发生。

Objective To explore the clinical outcome of complete posterior spinal canal decompression, vertebral interbody fusion and transpedicular screm fixation for the surgical treatment of recurrent lumbar disks herniation after discectomy. Method 20 cases treated surgicatly with posterior dose excision, complete spinal decompression, vertebral interbody fasin with cage and transpedicular screw fixation were reviewed retrospect ivty. The surgical results were eraluated with Japanese Orthopedic Association score （JOA, 15 scores）, patient＇s subjective satisfaction degree, complications and radiographic findings were reviwed either. Result The average operative time was （162±2.4）min and the intraopetive blood volumn was （640±5.6）ml. All cases were followed up for the average of 8 months. Radiographic fusion was evidenced in 95. 64% of patients, there was a siguificaut in crease of JOA score in the test follow -up （P ≤ 0.05 ） 86.25% of patients graded their clinical outcome as excellent and good. Compications included dural tear in 4 cases, unilateral transient lower extremity paresthe sia in 1 case. Conclusion Complete spinal canal decompression vertebral interbody fusion and transpedcular screw fixation can deak with recurrent lumbar disks cherniation after discectomy, can ensure successful interbody fusion and reconstruction of stability.