复发性腰椎间盘突出症再手术的术式选择及疗效分析

Surgical outcomes for recurrent lumbar disc herniation

目的:探讨三种术式治疗复发性腰椎间盘突出症的疗效分析。方法:对我院2004年4月～2009年10月收治的随访资料完整的78例腰椎间盘突出症术后复发再次手术患者进行回顾性研究。按照再次术前患者情况及手术方法分三组:A组27例,术前无腰椎失稳、退变性滑脱或椎管狭窄,再次行椎间盘摘除术;B组15例,术前合并腰椎失稳、退变性滑脱或椎管狭窄,行椎间盘摘除+后外侧融合术(posterolateral fusion,PLF);C组36例,术前合并腰椎失稳,退变性滑脱或椎管狭窄,行椎间盘摘除+后路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF),B组、C组患者依据术前具体病情,术中均采用椎弓根螺钉内固定术。采用日本骨科学会(JOA)29分评分系统和腰痛及腿痛视觉疼痛评分(VAS)两项指标对患者术前、术后和末次随访时的神经功能及自觉症状进行评价,计算改善率,并对结果进行统计学分析。结果:78例患者再次术后均获得随访,随访时间6～36个月,平均24个月。JOA评分术前A组为9.96±2.59,B组为10.20±2.37,C组为9.14±3.16;术后2个月A组为20.37±5.21,B组为22.60±6.62,C组为21.45±6.09;末次随访A组为19.85±6.45,B组为20.40±6.47,C组为20.92±5.51。各组JOA评分与术前相比有统计学意义(P<0.05)。各组术前、术后及末次随访腰腿痛(VAS)评分,经配对t检验,差异有显著性(P<0.05);结论:腰椎间盘突出症术后复发根据不同病情采用不同的手术方式治疗,可以取得满意的临床效果。

Objective：To investigate the varied surgical outcome for recurrent lumbar disc herniation. Method：From April 2004 to October 2009,78 patients with recurrent lumbar disc herniation （32 males,46 females）with the mean age of 52.2 years （range,27-79 years） were involved in this study.Patients were assigned into 3 groups according to preoperative diagnosis and revision protocols classification as followers： group A （n=27） with no lumbar vertebrae instablility or lumbar spinal stenosis and underwent discectomy alone;group B （n=15） with lumbar vertebrae instability or lumbar spinal stenosis and underwent discectomy and posterolateral fusion（PLF）;group C（n=36） with lumbar vertebrae instability or lumbar spinal stenosis and underwent discectomy and posterior lumbar interbody fusion （PLIF）;both group B and group C had vertebral pedicle screw fixation;the clinical results of all patients were analyzed by JOA score （29 score）and VAS score.Result：All patients were followed up for an average of 24 months （range,6 months-36 months）.Before surgery,the JOA score for group A,B and C was 9.96±2.59,10.20±2.37 and 9.14±3.16 respectively;20.37± 5.21,22.60±6.62 and 21.45±6.09 for 2 months later respectively;and 19.85±6.45,20.40±6.47 and 20.92±5.51 respectively for final follow-up,which showed significant difference compared with preoperative ones （P0.05）. The VAS score for low back pain and leg pain in the group A,B and C showed significant difference compared with preoperative ones （P 0.05）.Conclusion：Surgical management for recurrent lumbar disc herniation（RLDH）should be individualized.