腰椎间盘退变性疾病术后短期内再手术原因分析与疗效

Cause and Clinical Effect of Reoperation for Degenerative Lumbar Disc Disease Patient in Short Term

目的探讨腰椎间盘退变性疾病手术后短期内再次手术的原因及干预方法。方法 2010年8月至2011年2月手术治疗腰椎管狭窄症、腰椎间盘突出症等腰椎间盘退变性疾病238例,手术方式包括髓核摘除、椎管减压、椎间融合、椎弓根螺钉内固定等。术后7例因腰腿痛及神经根性症状持续存在或加重在短期内进行再次手术,其中男2例,女5例,年龄47～67岁。再手术原因包括神经根管减压不充分伴髓核组织残留2例,椎弓根螺钉误置2例,椎间融合术后相邻节段退变2例,椎板切除减压、髓核摘除术后椎间不稳1例。结果 7例手术均顺利完成,有效随访6～12个月,术后视觉模拟疼痛评分和Oswestry功能障碍指数评分均有改善,腰腿痛及神经根性症状有所缓解,疗效满意。结论游离型腰椎间盘突出症容易发生髓核组织残留致神经根管减压不充分、椎弓根螺钉误置;要重视腰椎融合术后相邻节段退变发生的相关因素,有效预防和延缓相邻节段退变的发生。

Objective To discuss the cause and effect of reoperation of degenerative lumbar disc disease in short term.Methods From August 2010 to February 2011,238 patients with degenerative lumbar disc disease,including lumbar disc herniation（LDH）,lumbar spinal stenosis（LSS）,lumbar spondylolisthesis,were treated by surgical intervention.The procedures include discectomy,decompressive laminotomy,posterior lumbar interbody fusion（PLIF）,instrumentation with pedicle screw.Seven failure cases with persistence low back pain and symptoms of radiculopathy received reoperation in short term.The average age of the 2 males and 5 females was 55.3 years（range 47～67 years）.The revision procedures including residual discectomy,reposition of pedicle screw,decompression and lumbar interbody fusion were accomplished corresponding the cause of reoperation including incomplete decompression,malposition of pedicle screw,adjacent segmental degeneration（ASD） and iatrogenic instability.Results Seven revision cases were accomplished and followed up for 6～12 months successfully.The score of visual analogue scales（VAS） and Oswestry dysfunction index（ODI） were decrease and all patients′ symptom of low back pain and radiculopathy was relieved.Conclusion The bad clinical result after first surgical intervention for prolapsed lumbar disc herniation is more likely frequency from incomplete decompression.The new symptoms of radiculopathy are associated with malposition of pedicle screws.It is a key point to choose the fusion segments and procedures for multiple segment involved and pay more attention to corresponding factors of ASD and prevention of ASD after fusion procedure.