腰椎间孔镜术后复发的原因分析及对策

Causes of recurrence of herniated lumbar discs after lumbar transforaminal endoscopic surgery

目的探讨腰椎间盘突出症术后复发与腰椎间孔镜手术操作的关系,以便改进技术,减少复发概率。方法复发的24例再次行椎间孔镜手术治疗,结合患者症状体征、术前影像检查及术中镜下情况分析复发原因。术前及术后分别进行视觉模拟评分(visual analogue scales,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI)测定,比较手术前后评分变化情况。结果 24例复发率为0.86%,复发原因有纤维环医源性损伤、髓核摘除不彻底、关节突骨屑残留、终板损伤、血肿形成和神经根粘连。所有病例术后1年VAS评分2.61±0.19,低于术前的7.40±0.23,差异有统计学意义(P<0.05);术后1年ODI评分8.53±0.35,低于术前的67.90±3.47,差异有统计学意义(P<0.05)。结论术中准确定位、镜下严格按照微创理念操作,术后严密观察病情发展,及时处理有关并发症,可以有效降低腰椎间孔镜术后复发概率。

Objective To study the relationships between surgical procedures and the recurrence of herniated lumbar discs in order to improve surgical methods and reduce the chance of recurrence. Methods Clinical data on 2806 patients with herniated lumbar discs who had been operated on by removing nucleus pulposus using the transforaminal endoscopic spine system （TESSYS） in our hos- pital were retrospectively analyzed. Twenty-four of these cases received a second operation because of recurrence and were followed up for 3 months to 2 years by telephone or WeChat software. Results The causes of recurrence included iatrogenic injury to annulus fibro- sus, bone fragment residuals in case of processus articularis, cndplate injury, formation of hematoma, and nerve root adhesion. Conclusions There are many causes of recurrence of herniated lumbar discs ＇after lumbar transforaminal endoscopic surgery. The inci- dence of recurrence can be reduced if surgeons can find the exact location of herniated lumbar discs, operate carefully, keep track of the development of the disease ,and deal with postoperative complications promptly.