后路腰椎间盘镜微创术后复发的原因及二次椎间盘镜手术治疗

The reason of recurrence after posterior lumbar intervertebral disc mirror minimally invasive operation and the second intervertebral disc endoscope operation treatment

目的:探讨后路腰椎间盘镜微创术后复发的原因。方法:3年间首次腰椎间盘镜手术后复发经保守治疗疗效不佳,再次使用椎间镜手术,5例椎间盘镜下单纯摘除髓核,7例椎间盘镜下髓核摘除、减压、松解Cage植入椎间植骨融合术。结果:髓核遗漏1例,髓核同侧髓核脱出2例,髓核摘除不彻底对侧髓核脱出1例,瘢痕组织、终板组织脱出3例,合并侧隐窝狭窄2例,合并腰椎不稳3例。结论:腰椎间盘镜手术应遵循"慎于术前,精于术中,勤于术后"的原则,术前严格把握适应证;术中精细操作;术后勤观察、勤锻炼、勤随访。术后复发的原因与适应证选择不当、术中操作不彻底、术后未充分康复,活动不当有关。

Objective:To explore the cause of posterior lumbar discectomy minimally invasive recurrence after operation.Methods: The conservative treatment is poor after the recurrence of first time intervertebral disc endoscope operation in 3 years,use intervertebral arthroscopic surgery again,5 cases of simple endoscopic removal of nucleus pulposus of intervertebral disc,7 cases of disc endoscopic discectomy,decompression,release cage interbody fusion implant surgery.Results:One case of the missing nucleus,two cases of ipsilateral nucleus disc prolapse,one case is not complete discectomy contralateral nucleus prolapse,three cases of scar tissue,tissue prolapse endplate,two cases of lateral recess stenosis,3 patients with lumbar instability.Conclusion: Lumbar discectomy should follow the principle of 'cautious preoperative,intraoperative skilled,diligent after',preoperative strictly grasp indications;intraoperative fine operation.Surgery logistical observation,ground training,ground follow-up.The reason of recurrence and indications inappropriate choice,surgery operation is not complete,not fully recovered after surgery,activities related to inappropriate.