腰椎间盘突出症术后早期翻修原因分析

Analysis of revision surgery in the early stage after surgical treatment of lumbar disc hernia

[目的]探讨腰椎间盘突出症术后早期翻修原因及治疗效果。[方法]对2000年5月～2010年5月行腰椎间盘突出症手术3 800例进行回顾性分析,其中42例行早期(术后1个月内)手术翻修,术后硬膜外血肿8例,误诊4例(椎间孔外髓核突出),节段定位错误1例,游离髓核残留6例,术后残余髓核再突出2例,神经根管减压不足7例,椎弓根钉置钉失误6例,椎间融合器松动3例,腰椎术后感染5例。均行手术探查翻修。[结果]随访6～36个月,平均10个月。临床疗效(Macnab法):优18例,良16例,可8例。优良率81%。JOA评分:翻修手术前4～17分,平均11.6分,翻修手术后末次随访时16～28分,平均25.7分。JOA评分翻修手术后与术前比较有统计学差异(P<0.01),恢复率为81.4%。[结论]早期翻修原因与术者对病情的综合判断不足、手术经验缺乏及技术失误有直接关系。

[ Objective] To analyxe the early revision surgery after surgical treatment of lumbar disc hernia （LDH） and classify the reason of revision surgery. [ Methods ] Totally 3 800 cases suffered from LDH were surgically treated from May 2000 to May 2010 in our hospital, and 42 cases received revision surgery in the early stage （ in l month） because of some serious surgical complication. Among the 42 cases who received revision surgery, 8 cases were the epidural hematoma, 4 cases because of missed diagnosis of extraforaminal disc herniation, 1 case were wrong localization in surgery, 6 cases were rsidue of free nucleus pulposus, 2 cases were disc herniation again in the same segment, 7 cases were insufficient decompression of the nerve root, 6 cases were of fuh placement of the pedicle screw, 3 cases were loosening of the cage, 5 cases were postoperative infection. [ Results] After mean follow- up of 10 months （6 ± 36 months）, the outcome of revision surgical treatment showed excellent result in 18 cases （43%）, good in 16 cases （38%） and fair in 8 cases （19%） by Macnab methods. The average JOA scores before revision surgery were 11.6 （4 - 17 ）, and after revision surgery the average JOA scores were 25.7 （ 16 ± 28） . The mean JOA scores were obviously changed after the revision surgery （P 〈0. 05） and the recovery rate were 81.4%. [ Conclusion] The early revision surgery after surgical treatment of LDH has a direct relationship with deficient judgement of the patient＇ s condition, lack of surgical experience and fault in surgical technique.