复发性腰椎间盘突出症的手术疗效与方法选择

Effect of surgical treatment on recurrent lumbar disc herniation and the selection of treatment methods

目的 探讨复发性腰椎间盘突出症再手术方法的选择,并观察其疗效.方法 对52例腰椎间盘突出症术后复发者进行选择性再手术治疗.其中11例行原椎板间扩大开窗、髓核摘除;13例采用半椎板减压、小关节部分切除加髓核摘除;15例伴有椎节不稳或原先已采用半椎板减压者,行椎间盘切除加椎弓根螺钉固定椎间植骨融合术;13例有双侧下肢症状者,行全椎板减压、椎弓根钉固定、椎间1枚Cage融合器及1枚自体骨块融合.结果 所有患者手术后次日症状明显减轻,术后3周至6个月症状消失,随访5-72个月.JOA评分：再手术前平均10.9分,随访时平均25.8分.X线摄片复查：24例行扩大开窗髓核摘除者未见手术椎节不稳;28例椎弓螺钉内固定者同定椎节融合良好.结论 对于复发性腰椎间盘突出症经保守治疗无效者,再次手术方法选择正确,仍可获得较为理想的效果.

Objective To investigate the therapeutic effect on recurrent lumbar disc herniation and selection of treatment methods.Methods Fifty-two casels of recurrent lumbar disc herniation were performed with different methods of reoperation.of all the cases.11 were treated with enlarged fenestration at the initially operated site.Hemilaminectomy and partial facets joint were removed in 13 cases.Fifteen cases with lumbar instability were treated with hemilaminectomy combined with pedicle screw system and one cage inserted lumbar spatial and auto bone grafting at the other side lamina.Thirteen cases with instability and total laminectomy were treated with decompression and PLIF with one cage and one mass of bone graft in lumbar space.Results Au the patients had clinical follow-ups for 5 to 72 months.Results showed that symptoms in all the operated patients obviously relieved the day after surgery,almost disappeared in 3 weeks to 6 months.According to JOA score system criteria,average score increased from 10.9 before reoperation to 25.8 after reoperation.X-ray film revealed that lumbar instability was not seen in the 24 cases operated for removal of nucleus pulposus with enlarged fenestration,good vertebral joint fusion could be seen in 28 cases treated with screw fixation at pedicle of vertebral arch.Conclusions For patients who had recurrent lumbar disc herniation and did not respond to conservative treatment,ideal results could be achieved with correct selection of reoperation.