微创翻修治疗复发性腰椎间盘突出症(附39例报告)

Minimally invasive renovation surgery for recurrent lumbar disc herniation(report of 39 cases)

目的探讨微创翻修治疗复发性腰椎间盘突出症的疗效及复发的相关因素。方法 2008年1月至2010年10月采用微创翻修治疗复发性腰椎间盘突出症39例,其中显微内镜下微创翻修28例,应用Quadrant系统行椎间融合术微创翻修11例,同时分析腰椎间盘突出症复发的相关因素。术后随访11～38个月,平均(16.4±2.6)个月,通过影像学资料和末次随访时的临床表现进行Nakano标准疗效评定。结果依据Nakano标准评定疗效,39例患者中,优24例,良13例,中1例,差1例;优良率94.9%(37/39)。结论初次手术处理不当、神经压迫未完全解除以及术后腰椎局部生物力学的改变是腰椎间盘突出复发的主要原因;再次手术治疗复发性腰椎间盘突出症,应解决致压物或同时解决减压和稳定两个问题;选用微创翻修避开原手术切口的瘢痕组织,减少神经损伤和脑脊液漏等并发症,手术出血少,术后恢复快,可获得良好的效果。

Objective To investigate the curative effect of minimally invasive renovation surgery on the recurrent lumbar disc herniation （LDH） and the factors related to LDH relapse. Methods Of 39 patients with recurrent LDH treated by minimally invasive renovation surgery from January, 2008 to October, 2010, 28 treated by microendoscopie discectomy and 11 by quadrant minimally invasive system. The factors related to LDH relapse were analyzed. These patients were followed-up for （16.4 ± 2.6） months. The curative effect was assessed by the imaging examination, clinical manefestations and Nakano standard. Results All the patients were significant improved in the clinical symptoms. According to Nakano standard, the curative effect was excellent in 24 cases, good in 13, middle in 1 and poor in 1. The rate of good curative effect was 94.9% （37/39）. Conclusions The main causes of LDH relapse include the improper treatment by the initial surgery, incomplete removal of compression of the nerve and change in local biomechanics of lumbar spine after the operation. The complete decompression of the nerve and stability can be reached by minimally invasive renovation surgery. The scar tissues produced by the original incision should be avoided, and the damage to the nerve and leakage of cerebrospinal fluid should be prevented in order to obtain good curative effect while the second operation is performed in the patients with recurent LDH.