腰椎间盘突出症术后翻修术的原因分析

Reasons of Revision for Lumbar Disc Herniation

目的探讨腰椎间盘突出症翻修术的主要原因及手术方式。方法对86例腰椎间盘突出症翻修术的患者进行分析和总结。翻修方式:后路全椎板减压、椎间盘切除、椎间植骨融合、内固定。采用VAS和Oswestry功能障碍指数进行评估。结果复发性腰椎间盘突出34例,腰椎节段性不稳定15例,继发性椎管狭窄13例,相邻节段腰椎间盘突出6例,神经根粘连6例,极外侧型椎间盘突出遗漏5例,椎间隙感染4例,内固定失败3例。随访14～132个月,再手术前VAS评分为(8.9±1.1)分,Oswestry功能障碍指数(51.4±6.9)分。再手术后末次随访时VAS评分为(2.6±1.1)分,Oswestry功能障碍指数(17.7±3.9)分,有显著性差异(P<0.05)。所有患者末次随访时植骨融合率为100%。结论腰椎间盘突出症术后翻修的原因很多。再手术时正确分析其原因,采取积极、合理的治疗方案,可以取得满意的疗效。

Objective To analyze the reasons of the revision for the lumbar disc herniation.Methods Eighty-six patients with symptoms not improved or partially improved for a short time and recurring after lumbar diseectomy were reviewed.They underwent the total laminectomy, decompressive discectomy, interbody fusion and internal fixation, and the effects were evaluated by VAS scoring and Oswestry Disability Index.Results The reasons of reoperation included： recurrent lumbar disc herniation （34 cases）, postoperative segmental instability （15 cases）, secondary spinal canal stenosis （13 cases）, adjacent lumbar disc herniation （6 cases）, nerve root adhesion （6 cases）, extreme lateral lumbar disc herniation （5 cases）, surgical diseitis （4 cases）, and internal fixation failure （3 ease）. The follow-up time was from 14 months to 132 months,the VAS and Oswestry Disability Index decreased from （8.9±1.1） and （51.4±6.9） to （2.6±1.1） and （17.7±3.9） respectively. All patients got bone fusion after surgery.Conclusion The reasons of the revision for the lumbar disc herniation are complicat- ed. If the reasons of revision are analyzed correctly, and reasonable treatments are selected, and the satisfied effect could be obtained.