腰椎间盘突出症再次手术治疗

REOPERATION FOR DISC HERNIATION AFTER INITIAL LUMBAR OPERATION FOR DISC HERNIATION

目的：分析腰椎间盘突出症再次手术的原因，提出预防措施及再次手术注意事项。方法：回顾分析我院自１９８４年至１９９５年间再次腰椎间盘手术２９例，其中在我院第一次手术１９例占２８％，由外院转入１０例；复发时间２月－１１年，平均１０２±４２４月。结果：再次手术的主要原因是初次手术髓核摘除不彻底，多间隙椎间盘突出遗漏或再突出，腰椎管狭窄未解除及疤痕组织粘连压迫等。结论：初次手术前应明确所有诊断，术中应尽量彻底摘除核组织及解除椎管狭窄，要注意避免过分扩大减压导致脊柱不稳；二次手术时应从正常部位向粘连瘢痕部位细心分离，在直视下操作，在摘除髓核及椎管扩大减压同时避免损伤硬膜。

Objective: To analyze the causes of reoperation after initial removal of lumbar disc herniation and the notice for reoperation. Methods: 29 cases of reoperation after initial removal of lumbar disc herniation were analyzed,including 19 cases(2.8%) who had the initial operation in our hospital and 10 cases transfered from other hospitals.The interval of recurrence was between 2 months and 11 years,average 10.242.4 months. Results: The causes of reoperation were mainly due to insufficient removal of the nucleus,incorrect location of the herniated disc or recurrence of the disc prolapse,unadequate decompression,adhesion and compression of the scar tissue.WTHZ]Conclusion: The diagnosis should be definite before the initial operation and the herniated disc should be removed as much as possible.In the cases with stenosis,decompression procedure should be carried out concurrently.It is desirable to maintain the stability of the spinal column.The exposure of reoperation should be started from the normal site adjacent to scar area and the operative procedure must be done under direct vision.The dura,nerve root,and cauda equina should be protected carefully.