腰椎间盘突出症再手术原因及疗效分析  

Analysis of the reasons for failed lumbar disc hernition surgery and the curative effect of reoperation

作　　者：黄永栋[1] 蒋卫平[1] 韦冰丹[1] 杨晓明[1] 甘坤宁[1] 兰学文[1] 周坚平[1] 刘剑伟[1] 

机构地区：[1]广西医科大学第三附属医院骨二科,广西南宁530031

出　　处：《中国现代医药杂志》2009年第5期56-58,共3页Modern Medicine Journal of China

摘　　要：目的探讨腰椎间盘突出症手术失败的原因及再次手术的疗效。方法对我院腰椎间盘突出症术后再次手术的23例进行分析,其中男9例,女14例;年龄24～63岁,平均36.8岁。再次手术原因:术前定位失误7例,多间隙突出遗漏3例,原间隙再突出4例,双侧型或中央型突出只切除一侧2例,中央管狭窄及神经管狭窄未根除4例,椎板减压术后腰椎节段不稳3例。再次手术方法:开窗法间盘摘除术11例,半椎板切除减压加间盘摘除术5例,全椎板切除减压、间盘摘除、神经根管松解术4例,全椎板切除减压、后外侧植骨融合椎弓根螺钉固定术3例。结果23例患者术后获得随访,平均随访18个月(14～36个月)。根据Macnab评分法进行术后疗效评定,优10例,良7例,可4例,差2例,优良率为73.9%。结论严格掌握再次手术指征,选择合理的手术方法与入路,术中准确定位,解除椎管狭窄及重建脊柱的稳定性,可使再次手术获得较满意的疗效。Objective To analyze the reasons for failed lumbar disc hernition surgery, and the curative effect of reoperation. Methods 23 patients （9 males,14 females, with the mean age 36.8 years） with failed surgery for lumbar disc herniation involved in this study. The causes of reoperative ：7 cases were at fault of the localization, 3 cases were wrong intraoperative location,4 cases were protrusion of primary interspace, 2 cases were neglector multiple intervertebral space, 4 cases were incomplete decompression of central canal and nerve root canal, 3 cases were postoperative lumbar segmental unstability after total lamineetomy. The methods of reoperative ：11 cases underwent fenestration, 5 cases did semi-laminectomy, 4 cases did total laminectomy, 3 cases did total lamineetomy and pedical screw fixation and bone graft. Results 23 cases got following up with an average 18 moths （range 14-36 months）. Acording to Macnab＇s criteria, outcomes were 10 excellent, 7 good, 4 fair and 2 poor, the satisfactory rate was 73.9%. Conclusion Checking of screenage in preoperative,chose reasonable surgical methods and approchs, loealizate exactly in reoperation, relieve the constriction of lumbar spinal canal or lateral recess, rehabilitate the spinal stabilization, can make reoperation achieve satisfactory result.

关 键 词：腰椎间盘突出症 再手术 原因 疗效 

分 类 号：R687.3[医药卫生—骨科学]