椎间盘镜下髓核摘除术后再次手术的原因及对策

Analysis of reoperative treatment of lumbar disc herniation after operation with microendoscopic discectomy

目的 :研究了椎间盘镜下髓核摘除术后再次手术的原因 ,并探讨相应的对策。方法 :经临床观察和治疗腰椎间盘突出症椎间盘镜下术后再次手术患者 17例 ,对各个病案手术失败的原因进行仔细分析。结果 :17例患者需再次手术的原因有 :过于依赖CT等检查、定位错误、术前适应证掌握不当、术中髓核摘除不够、术后限制活动时间不足、疤痕组织的形成、多节段突出处理不当、神经根未彻底松解及影像假象误导等。结论 :为避免再次手术应做到不能过分依赖CT等检查 ,应该进行严格的体格检查、必须术前有足够大范围的摄片及仔细认真的阅片、严格掌握腰椎间盘突出症的手术适应证、术后需避免剧烈活动或搬抬重物、多节段椎间盘突出症摘除突出物的取舍应将术前症状体征与术中探查结合起来而决定。

Objective: To find out the cause of failed primary operation for lumbar disc herniation after microendoscopic discectomy.Method:Seventeen cases of failed primary surgical management of lumbar disc herniation were reviewed in order to analyze the failure reasons.Results:The reasons accounted for failed primary surgical management in 17 cases of lumbar disc herniation included:too dependent on CT,error anchor point,mistake indication,incomplete decompression,and so on.Conclusion:In order to avoid reoperation,doctor must make stringent physical examination,read X-ray image carefully et al.before operation,should not too dependent on CT,right indication,complete decompression and patient must not do acute exercise or bear heavy objects after operation.Decompress point depend on clinic symptom and exploration in several lumbar disc herniation patients.