后路减压椎间融合内固定治疗复发性腰椎间盘突出症

Treatment of recurrent protrusion of lumbar disc by posterior decompression and interbody fusion

目的 探讨复发性腰椎间盘突出症的原因和后路椎弓根螺钉固定及椎间融合术治疗的临床效果.方法 2006年12月～2012年12月对35例复发性腰椎间盘突出症患者应用后路椎板扩大切除减压椎间植骨融合内固定手术治疗,其中30例得到随访,手术前后采用视觉模拟评分法（VAS）评估患者术前及术后第1、14天与末次随访的疼痛程度.结果 术后随访时间6～36个月,所有患者腰腿病症状均得到有效缓解.术前腰腿痛VAS评分为（8.34±1.56）分,术后VAS评分第1天为（4.12±1.26）分,14天为（2.23±1.12）分,末次随访为（1.56±1.13）分.所有患者的VAS评分术后明显低于术前,差异有统计学意义（P＜0.05）;术后第14天及末次随访时VAS评分明显低于术后第1天,差异有统计学意义（P＜0.05）.术后第14天及末次随访时VAS评分差异无统计学意义（P＞0.05）.结论 手术技术不当,术后锻炼不当,术后病变节段的退变,是复发的主要原因.再次手术减压联合椎间固定融合治疗复发性腰椎间盘突出症疗效肯定,可作为治疗腰椎间盘突出症的一种选择方法.

Objective To investigate the etiology and clinical effect of recurrent protrusion of lumbar disc treated by posterior pedicle screw fixation and interbody fusion.Methods 35 cases with recurrent lumbar disc protrusion were treated with posterior extended vertebral plate discectomy,interbody fusion and fixation and 30 cases were followed up.The degree of pain of patients with preoperative and 1 and 14 days after operation and final flollow-up was scored by visual analogue scale （VAS）.Results Patients were followed up 6-36 months,the low back pain obviously relieved after operation.The VAS of low back pain was 8.34± 1.56 for preoperation,4.12± 1.26 for the first day postoperation,2..23 -±-1.12 for the fourteenth day postoperation and 1.56± 1.13 for final flollow-up.According to VAS score,there was significant difference between the patients preoperation and postoperation,between the 14th,final fellow-up day respectively and the first day （P〈0.05）.Conclusion The improper treatment of the first time,improper postoperative exercise and biomechanics change of lumbar spine after surgery are the main cause of lumbar disc recurrent protrusion.Decompression and interbody fusion fixation is a choice for the treatment of recurrent protrusion of lumbar disc.