腰椎间盘突出症手术失败原因分析及再手术方式探讨  

Analysis of the Causes for Failed Lumbar Disc Herniation Surgery and the Methods of Reoperation

作　　者：朱健[1] 余黎明[1] 张克云[1] 林昕[1] 田科良[1] 瞿哲[1] 

机构地区：[1]湖南怀化医专附属医院暨怀化市第三人民医院骨科,湖南怀化418000

出　　处：《医学临床研究》2008年第10期1759-1762,共4页Journal of Clinical Research

摘　　要：【目的】探讨腰椎间盘突出症手术失败的原因及再手术方式。【方法】对33例腰椎间盘突出症手术失败需再手术治疗患者的临床资料进行回顾性分析。根据改良Macnab法、术前及再手术后末次随访时JOA评分及影像学结果评价临床疗效。【结果】手术失败原因包括复发性腰椎间盘突出17例、相邻节段腰椎间盘突出5例、腰椎节段性不稳定7例和腰椎间盘切除不彻底4例,其中合并继发性腰椎管狭窄7例,硬膜外瘢痕形成4例。再手术中发生脑脊液漏4例,均行硬膜修补,术后恢复良好;术后出现一过性单侧神经根麻痹1例,经脱水、营养神经等保守治疗好转。再手术后随访24～52个月,平均34.8个月,根据改良Macnab法:优11例、良15例、可6例、差1例,优良率为78.80%。再手术前JOA评分平均11.2分,未次随访时平均25.4分,差异有统计学意义(P<0.05),平均改善率为79.80%。行后外侧融合患者20例,椎间融合2例,融合率86.4%。【结论】腰椎间盘突出症手术失败的主要原因为复发性或相邻节段椎间盘突出、节段性不稳和髓核摘除不彻底等,正确分析手术失败原因并选择合理的再手术方式,仍可取得满意疗效。[Objective]To analyze the causes for failed lumbar disc herniation surgery, and investigate the methods of reoperation. [Methods]The clinical data of the 33 patients with failed lumbar disc herniation surgery and reoperation requested were analyzed retrospectively. The clinical efficacy was evaluated by revised Macnab system,JOA scores before reoperation and the latest follow up after reoperation and radiographic findings. [Results]The causes of failed surgery included recurrent lumbar disc herniation （17 cases） ,adjacent lumbar disc herniation（5 cases）, postoperative segmental instability （7 cases） and incomplete lumbar discectomy（4 cases）. And there were 7 cases with coexisting secondary spinal canal stenosis and 4 cases with epidural scar formation among them. Four patients with cerebrospinal fluid leakage during surgery and 1 case with unilateral transient lower extremity paresthesia after operation recovered better. All the cases were followed up from 24 to 52 months after reoperation （34.8 months on average）. The clinical results were assessed according to revised Macnab system as excellent in 11 cases, good in 15, fair in 6 and poor in 1, the excellent and good rate was 78. 80%. The JOA score averaged 11. 2 points before reoperation, and the latest followed-up JOA in- creased to 25.4 points after reoperation （ P〈0.05）,with the mean recovery rate of 79.80~. Twenty cases obtained posterolateral fusion,and 2 cases got interbody fusion, and the fusion rate was 86.40 %. [Conclusion] Recurrent lumbar disc herniation, adjacent lumbar disc herniation, postoperative segmental instability and incomplete lumbar discectomy are the main causes of failed surgery. If the causes of failed surgery are analyzed correctly and.the types of surgery selected reasonably, satisfactory effect could be obtained.

关 键 词：椎间盘移位/外科学 治疗失败 再手术 

分 类 号：R681.53[医药卫生—骨科学]