腰椎椎间盘突出症再手术治疗的临床分析

Clinical analysis of reoperation to lumbar disc herniation

目的总结腰椎椎间盘突出症再手术治疗的临床疗效。方法回顾总结2002年1月～2009年5月收治的78例采用腰椎单枚斜向融合器椎间融合、椎弓根螺钉内固定术治疗的腰椎椎间盘突出症再手术患者的临床资料,男48例,女30例;年龄为41～78岁,平均为62.4岁。术后应用Oswestry功能障碍指数(Oswestry disability index,ODI)、VAS评分及影像学检查对临床疗效进行评价。结果手术时间平均150min(120～210min)。随访0.5～5年,平均3.9年。术后椎间隙高度得到明显恢复,末次随访高度未见明显丢失。VAS评分由术前的7.3±1.4减至末次随访时的2.2±0.6,ODI由术前的59.6%±9.4%减至末次随访时的28.4%±3.2%。在随访期间VAS评分及ODI均得到明显恢复,与术前相比差异有显著统计学意义(P<0.01)。结论腰椎椎间盘突出症再手术患者多伴有椎间隙狭窄和节段性失稳,其治疗需要兼顾减压和稳定两个方面,腰椎单枚斜向融合器椎体间融合术不失为一种较为理想的手术方式。

Objective To explore the clinical outcomes of reoperative treatment for lumbar disc herniation after standard discectomy.Methods From January 2002 to May 2009,78 patients underwent reoperation with posterior lumbar interbody fusion using one diagonal fusion cage with transpedicular screw/rod fixation.There were 48 males and 30 females.The average age of the patients was 62.4 years（ranging from 41 to 78 years）.VAS scores and Oswestry disability index were used to assess clinical outcomes.Disc height and bone union were examined.Results The total operating time ranged from 120 to 210 min with a mean time of 150 min.All the cases were followed up for an average time of 3.9 years（ranging from 0.5 to 5 years）.Disc space height was restored obviously by the surgery and maintained at the latest follow-up.The VAS scores reduced from 7.3±1.4 preoperatively to 2.2±0.6 at the latest follow-up,and the Oswestry disability index reduced from 59.6%±9.4% preoperatively to 28.4%±3.2% at the latest follow-up.The VAS scores and Oswestry disability index improved obviously,and there were significant statistic difference between preoperative and postoperative data（P0.01）.Conclusion Patients who underwent standard discectomy for lumbar disc herniation previously has particular characters like disc space narrowed and segmental instability.The reoperative treatment should deal with decompression and stability simultaneously.Posterior lumbar interbody fusion using one diagonal fusion cage is a good alternative.