腰椎间盘突出症术后再手术原因分析与对策

Causes of reoperation and countermeasures for lumbar disc herniation

目的分析腰椎间盘突出症术后再手术原因并探讨诊疗策略。方法回顾分析39例腰椎间盘突出症再手术患者的病史、体格检查、影像学表现、初次手术方案、再次手术探查结果及相应的再次手术方案。结果腰椎间盘突出症术后再手术的主要原因有：①椎间盘突出。②腰椎不稳。③椎管狭窄。④椎管内瘢痕形成。⑤漏诊和（或）误诊。39例均获随访,时间3-36个月,腰椎术后临床疗效评定参考侯树勋等制定的评价标准：优23例,良8例,可5例,差1例。颈椎手术1例术后JOA评分17分,疗效为优;胸椎手术1例,参考脊柱手术后Beau jon-Lassale功能评分标准评分：20分,疗效为优。结论腰椎间盘突出症初次术后,腰腿痛复发或症状无缓解甚至加重,原因大部分为医源性。应严格把握手术指征,针对不同病因对患者制定个性化再手术方案。

Objective To analysis the causes of reoperation and countermeasures for lumbar disc herniation. Methods 39 reoperation cases for lumbar disc herniation were investigated retrospectively. The data were collected about the history , physical examination ,image , first operation, reexploration and treatment protocols. Results The causes of reoperation for lumbar disc herniation were as follows ： （1） disc herniation ;（2） secondary lumbar instability ; （3） spinal stenosis ; （4） cicatrization in vertebral canal ; （5） missed diagnosis and/or misdiagnosis. 39 were followed up for 3 months to 36 months. The outcome was evaluated according to the standard of HOU Shu-xun＇s ： excellent in 23 cases, good in 8, fair in 5, and poor in 1 case ; 1 case with cervical operation got JOA scores of 17 points with excellent efficacy; 1 case with thoracic spinal surgery got Beaujon-Lassale function scores of 20 points with excellent efficacy. Conclusions There are many reasons for recurrency or unrelief and aggravation of back leg pain after the operation of lumbar disc herniation, while most-of them are iatrogenic origin. Surgical indications should be strictly controlled, and personal reoperation programme should be developed for different causes of the patients.