腰椎间盘突出症再手术原因分析与手术方式选择

A Study on Reoperation Causes and Surgical Options for Lumbar Disc Herniation

目的分析腰椎间盘突出症再手术的原因,并探讨其诊疗策略。方法对37例腰椎间盘突出症术后再手术患者的资料进行分析和总结,评价其再手术的疗效。结果再手术的主要原因有：诊断及定位错误2例,术后椎间盘炎2例,复发性椎间盘突出13例,椎管内瘢痕形成和神经根粘连4例,节段性失稳5例,椎管狭窄9例,节段性失稳伴椎管狭窄2例。随访6个月~4.5年,28例患者症状明显改善,8例症状部分改善,1例无改善,临床疗效优良率为75.7%（28/37）。再手术前JOA评分为（12.5±2.7）分;再手术后末次随访时为（24.3±4.9）分,两者比较,差异有统计学意义（P〈0.05）,再手术后恢复率为71.5%。结论腰椎间盘突出症再手术的原因较多,正确分析再手术原因,严格把握手术指征,针对不同病因选择合理的手术方式,仍可获得较为满意的疗效。

Objective To analyze the causes of reoperation for lumbar disc herniation and investigate the surgical options.Methods The data of 37 reoperation cases with lumbar disc herniation were collected and analyzed retrospectively,and the curative effect of reoperation was evaluated.Results The causes of reoperation included misdiagnosis or errors of locating diagnosis（2 cases）,postoperative discitis（2 cases）,recurrent lumbar disc herniation（13 cases）,scar formation in lumbar spinal canal（4 cases）,postoperative segmental instability（5 cases）,spinal canal stenosis（9 cases）,and postoperative segmental instability with spinal canal stenosis（2 cases）.The follow-up time ranged from 6months to 4.5 years.The clinical symptoms of 28 patients improved significantly,those of 8 patients improved partially,and those of 1 patient didn′t improve.The clinical improvement rate was 75.7%.The mean of the JOA scores（12.5±2.7）before reoperation was significantly different from that of the latest follow-up（24.3±4.9）（P0.05）.The recovery rate after reoperation was 71.5%.Conclusion There are many reoperation causes for lumbar disc herniation,but Satisfying curative effect could be obtained if the causes of reoperation are found correctly,the surgical indications are controlled strictly,and the reoperation methods are selected appropriately.