复发性腰椎间盘突出症的手术治疗策略  

Surgical strategy of recurrent lumbar disc herniation

作　　者：刘郑生[1] 侯克东[1] 曹勇[1] 王岩[1] 肖嵩华[1] 朱守荣[1] 张永刚[1] 

机构地区：[1]解放军总医院骨科,北京市复兴路28号100853

出　　处：《中国矫形外科杂志》2007年第7期484-486,490,共4页Orthopedic Journal of China

摘　　要：[目的] 探讨复发性腰椎间盘突出症患者的病因和手术治疗方法.[方法] 回顾性分析1996年12月～2003年12月收治的获得1～5年随访的复发性腰椎间盘突出症患者74例.男41例,女33例;年龄21～53岁,平均37.2岁.初次手术术式：全椎板间盘切除术9例;半椎板间盘切除术23例;椎板间开窗间盘切除31例;间盘镜显微间盘切除术11例.初次手术至复发时为6～192个月,平均37个月.再次手术术式：5例再次行腰椎间盘切除术;69例采用椎体融合术,其中45例采用PLIF手术,23例采用TLIF手术.[结果] 本组无围手术期死亡病例.出现并发症18例次,经对症处理后好转.行间盘切除术患者术后3周配戴腰围下床活动;行融合手术患者3～5 d下床活动.平均随访18个月,Oswestry评分从术前（52.32±9.17）分改善至（20.33±5.72）分.73.5%的患者对手术疗效满意.[结论] 复发性腰椎间盘突出症患者根据影像学和临床表现及手术史,采用相应的手术方法,充分减压,可获得较满意的临床疗效.[ Objective ] To investigate surgical therapeutic methods of recurrent lumbar disc herniation （RLDH）. [ Method] From December 1996 to December 2003, a retrospective analysis on surgical treatment of 74 cases of RLDH was made and those cases acquired 1 ~5 years follow-up. There were 41 males, 33 females aging from 21 ~53 years （mean, 37. 2 years） , case history was 6 ~ 192 months from primary surgery to disc reprolapse （mean, 37 months）. Among primary surgery, 9 cases were total laminectomy, 23 cases were hemilaminectomy, 31 cases were windowing, 11 cases were microdiscectomy with diskoscope. Re - surgery ： 5 cases treated with lumbar disc excision, 45 cases treated with posterior lumbar interbody fusion （PLIF） technich, 23 cases treated with transforminal lumbar interbody fusion （TLIF） technich. [ Result] No death case occurred during peri-operation. Various complications were found in 18 cases which recovered by symptomatic treatment. Cases with lumbar disc excision left bed in 3 weeks with the help of lumbar back brace and cases with fusion surgery left bed in 3 ~ 5 d after surgery. Oswestry score improved from （52. 32 ± 9. 17 ） pre-operatively to （20. 33 ± 5.72） in average 18 months followup. Totally 73.5% cases had satisfactory surgical results. [ Conclusion] Cases with RLDH can adopt propotional surgical methods, thoroughly decompression and gain satisfactory therapeutic effect on bases of imageology, clinical manifestation and surgery history.

关 键 词：复发性腰椎间盘突出 手术治疗 

分 类 号：R687.3[医药卫生—骨科学]