腰椎间盘突出症术后早期再手术临床分析  

Clinical Analysis of Early Reoperation of Lumbar Intervertebral Disc Protrusion Patients after Operation

作　　者：李翔[1] 张媛媛[1] 赵则雪[1] 

机构地区：[1]南京医科大学附属淮安一院骨科,江苏淮安223300

出　　处：《临床误诊误治》2016年第8期52-56,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨腰椎间盘突出症术后早期再手术的原因及其治疗方法,为此类患者降低再手术发生率和提高再手术治疗效果提供参考。方法回顾性分析2008年8月—2015年6月本院收治的腰椎间盘突出症术后3个月内需再手术30例的临床资料,通过影像学检查与Macnab法及日本矫形外科协会（JOA）关于下腰痛的评分系统综合评价再手术治疗效果。结果本组早期再手术原因：椎弓根螺钉进入椎管及减压不彻底各8例,椎管内血肿形成、钉棒系统松动及手术方式选择不当各4例,椎管内感染2例。再手术方式：内固定系统调整术12例,椎管扩大减压髓核摘除术7例,减压附加内固定植骨融合术5例,椎管探查血肿清除术4例,彻底清创负压封闭引流技术冲洗引流并二期缝合2例。再手术术中出血量平均446 ml;手术时间平均1.5 h。临床疗效：优6例,良18例,可4例,差2例;优良率80.0%。JOA评分：再手术前3~18分,平均11.8分;再手术后末次随访时12~28分,平均25.6分;恢复率为80.2%。30例平均随访16.7个月,症状均明显缓解,附加内固定患者X线检查显示植骨均达骨性融合,未见内固定松动或断裂。结论腰椎间盘突出症术后早期再手术原因较复杂,但仔细分析前次手术失败原因,充分术前准备,个体化再手术仍有望获得较好治疗效果。Objective To investigate the reasons and therapeutic methods of early reoperation of lumbar disc protrusion after operation,and provide clinical reference in order to reduce the incidence of reoperation as well as improve the surgical curative effect. Methods A total of 30 patients with recurrent lumbar disc herniation 3 months after surgery during August2008 and June 2015 were retrospectively analyzed in our hospital. By imaging examination,Macnab score system and the Japanese orthopaedic association（ JOA） of low back pain score system,the efficacy of reoperation were comprehensively evaluated. Results There were several early reoperation reasons as follows： 8 cases of misimplanting of pedicle screws,8 cases with incomplete decompression,4 cases of spinal canal hematoma formation,4 cases of loosing internal fixation system,4 cases of improper original surgery options and 2 cases of spinal canal infection,with the reoperation methods including adjustment of 12 cases of internal fixation system,7 cases of expanding vertebral canal decompression and excising the residual nucleus pulposus,5 cases of decompression,internal fixation and interbody fusion,4 cases of vertebral canal probe and removal of hematoma,2 cases of radical debridement,vacuum sealing drainage（ VSD） combined with secondary wound suturing. The average amount of bleeding during reoperation was 446 ml. The clinical efficacy was： excellent in 6 cases,good in 18 cases,moderate in 4 cases and poor in 2 cases,the excellent plus good rates were 80. 0%. JOA score： 3 ~ 18 scores before surgery,averaging 11. 8 scores; 12 ~ 28 scores after reoperation at the time of last follow-up,averaging 25. 6 scores. The recovery rate was 80. 2%. The average follow up time was 16. 7 months,the patient＇s symptom was allieviated. X-ray of patients of additional internal fixation showed successful osseous fusion of bone graft without internal fixator loosening or broken. Conclusion The reasons of early reoperation of lumbar disc protrusion after operation are

关 键 词：椎间盘移位 再手术 早期 

分 类 号：R687.3[医药卫生—骨科学]