复发性腰椎间盘突出症的手术治疗

Surgical treatment of recurrent lumbar disc herniation

目的探讨采用扩大开窗法或椎管彻底减压、后路cage椎间植骨融合、椎弓根系统内固定术治疗复发性腰椎间盘突出症的效果。方法回顾性分析该院2004年12月～2008年4月期间采用扩大开窗法或椎管彻底减压、后路cage椎间植骨融合、椎弓根系统内固定术治疗复发性腰椎间盘突出症共51例,根据JOA评分和影像学结果评价治疗效果。结果扩大开窗组JOA评分术前(7.9±2.7)分,末次随访时(21.2±5.5)分,优良率89.66%。内固定融合组术前JOA评分(5.3±2.8)分,末次随访时(20.5±5.9)分,优良率81.82%,骨性融合率100%。结论根据术前和术中对患者病情的判断和评估,采用扩大开窗法或椎管彻底减压、后路cage椎间植骨融合、椎弓根系统内固定术治疗复发性腰椎间盘突出症,能够提高优良率和患者满意度,减少并发症的发生。

[ Objective] This study probes into the effect of surgical therapeutic methods regarding recurrent lumbar disc herniation （RLDH）. [Methods] Reviewing 51 cases which have been undergone larger vertebral plate discectomy （group A） or complete posterior spinal canal decompression, vertebral Cage interbody fusion and transpedicular screw fixation （group B） during December 2004 to April 2008, after retrospective analysis were done, the effect of treatment evaluation that based on the JOA score and imaging has been assessed. [Results] Clinical outcomes were excellent or good in 89.66% of the group A, and 81.82% of the group B. The JOA score of preoperative were （7.9±2.7） and （5.3±2.8）, respectively. And the JOA score of the end of follow-up were （21.2±5.5）, （20.5±5.9）, respectively. The rate of bone fusion was 100%. [Conclusions] It can increase good rate and decrease concurrent disease that according to the assessment of the preoperative and intraoperative situation,choose larger vertebral plate discectomy or complete posterior spinal canal decompression, vertebral Cage interbody fusion and transpedicular screw fixation to treat recurrent lumbar disc herniation.