脊柱植入物内固定治疗腰椎间盘突出症的复发因素

Recurrence factors of spinal implant fixation for the treatment of lumbar disc herniation

背景:根据腰椎间盘突出症的具体类型和特点,选择正确的治疗方法,大多均可获得较为理想的效果,但在临床上,仍有部分腰椎间盘突出症患者治疗后症状复发。目的:探讨脊柱植入物内固定治疗腰椎间盘突出症复发因素及其干预处理措施。方法:回顾分析解放军第306医院骨科2002年1月至2007年12月收治腰椎间盘突出症内固定治疗后症状复发的52例患者,男28例,女24例,年龄25-52岁,平均年龄43.2岁。初次内固定治疗至症状复发时间为3-192个月,平均38个月。患者有腰部及双侧/单侧下肢疼痛及麻木症状。所有患者均行腰椎前后正侧位片、过伸过屈侧位X射线片,以评价腰椎的稳定性,行腰椎磁共振成像检查观察腰椎内固定治疗节段间盘情况以及合并椎管狭窄和椎间盘退变情况。结果与结论:52例患者其中22例由于初次植入物内固定治疗导致同节段间盘组织突出复发;4例因植入物内固定治疗后椎间盘炎引起症状;5例出现植入物内固定治疗部位瘢痕粘连压迫神经;10例出现植入物内固定治疗后侧隐窝或神经根管狭窄出现症状;11例因植入物内固定治疗后腰椎失稳导致症状复发。分析植入物内固定治疗腰椎间盘突出后症状复发的具体原因,有现实的临床意义。

BACKGROUND：The correct method selected according to the specific type and characteristics of lumbar disc herniation can achieve satisfactory effect, but in clinic, there stil some patients have recurrence symptoms after treatment. OBJECTIVE：To investigate the recurrence factors of spinal implant internal fixation for the treatment of lumbar disc herniation, as wel as the intervention measures. METHODS：Fifty-two patients with recurrence symptoms of lumbar disc herniation after internal fixation from January 2002 to December 2007 in the Department of Orthopedics, the 306th Hospital of PLA were retrospectively analyzed, including 28 male cases and 24 female cases, the average age was 43.2 years, ranged from 25-52 years. The time form first internal fixation to the recurrence was 3-192 months, average 38 months. The patients had the symptoms of lumbar and bilateral/unilateral leg pain and numbness. Al the patients underwent the anteroposterior radiographs of lumbar spine and the hyperextension and flexion lateral X-ray films to evaluate the stability of the lumbar spine. Lumbar magnetic resonance imaging was used to observe the intervertebral disc situation of the segment treated with lumbar internal fixation as wel as the spinal stenosis and disc degeneration. RESUTLS AND CONCLUSION：Among the 52 patients, 22 cases had recurrence lumbar disc herniation on the same segment after first internal fixation;four cases had recurrence symptoms caused by the spondylodiscitis after implant internal fixation;five cases had scar adhesions caused nerve compression on the site treated with internal fixation;10 cases had the symptoms of lateral recess and nerve root canal stenosis on the site treated with internal fixation;11 cases had recurrence symptoms caused by lumbar instability after internal fixation. It has reality clinical significance to analyze the reasons of recurrence of lumbar disc herniation after internal fixation