显微椎间盘切除治疗术后复发性腰椎间盘突出症

Outcomes of microdiscectomy for treatment of recurrent lumbar disc herniation

目的评价显微椎间盘切除治疗复发性腰椎间盘突出症的临床疗效。方法18例复发性腰椎间盘突出症（再手术组）接受小切口显微腰椎间盘切除术，与30例初次显微手术（初手术组），比较两组手术时间、术中出血量与住院时间。术后疗效评价采用MacNab法。结果再手术组手术时间平均75min；初手术组平均52min；再手术组术中出血量平均70ml；初手术组平均50ml；再手术组术后住院时间平均8．5d；初手术组平均6．5d。再手术组术中损伤硬膜1例，2例腰5神经根损害加重，5例术后麻木加重，术后均恢复。初手术组术中硬膜损伤1例。再手术组17例获平均12．1个月随访。优良率为88．2％。初手术组29例获平均11．8个月随访，优良率为93．1％。两组疗效比较差异无统计学意义（P〉0．05）。结论小切口显微椎间盘切除治疗复发性腰椎间盘突出症能取得与初次手术相近的临床疗效。

Objective To evaluate the outcomes of microdiscectomy for treatment of recurrent lumbar disc herniations. Methods There were 18 cases of recurrent lumbar disc herniations accepted microdiscectomy （reoperation group）, compared with 30 cases of primary lumbar microdiscectomy （primary group）. Operating time, blood loss and length of hospital stay were compared between two groups. MacNab criteria were used to evaluate the outcomes. Results Operating time was a mean of 75 min in reoperation group, 52 min in primary group. Blood loss of reoperation group was 70 ml, 50ml in primary group. Length of hospital stay was 8.5d in reoperation group, 6.5d in primary group. There were one dural tear, two L5 root lesions and 5 more numbness reoperation group, but recovery all patients. There were one dural tear in primary group. 17 cases got follow-up mean 12.1 months in reoperation group and 29 cases in primary group mean 11.8 months. The results demonstrated 88.2% success rate in reoperation group and 93.1% in primary group. There was no significant difference in two groups （P 〉 0.05）. Conclusion Outcomes of Lumbar microdiscectomy with mini-open for treatment of recurrent lumbar disc herniations are similar to primary lumbar microdiscectomy.