腰椎间盘镜术后再手术的原因分析及对策

目的:探讨腰椎间盘镜术后再手术的原因及对策,明确椎间盘镜术的减压原则。方法:经首次腰椎间盘镜手术后需再次手术的患者11例,男4例,女7例;年龄28~52岁,平均34.5岁。再手术方式:腰椎间盘镜手术2例,开窗减压术4例,环形减压术4例,半椎板切除术1例,术后对再手术原因进行回顾性分析。结果:再手术原因:定位错误2例,游离髓核遗漏1例,同侧髓核再脱出1例,对侧再突出2例,仅摘除髓核而未解除侧隐窝狭窄5例。术后随访8~20个月,平均13个月,按Nakai标准评定,优7例,良3例,可1例。结论:腰椎间盘镜手术应遵循"以神经根为中心减压"的原则,术后复发的原因与适应证选择不当、定位错误及手术技巧有关,再次手术可获得满意的疗效。

The causes and solutions of re-operative treatment after operation with micro-endoscopic discectomy system

Objective:To explore the causes and solutions of re-operative treatment after operation with micro-endoscopic discectomy (MED) system and determine decompression principle of micro-endoscopic discectomy system. Methods: Elven patients who needed re-operative after first operation of MED included 4 male and 7 female, ranging in age from 28 to 52 years (mean 34.5 years). Further surgical methods were involving MED in 2 cases, windows decompression in 4, circular decompression in 4 and half laminectomy excision in 1. Retrospective analysis of the patients was made.Results: The reason for the re-operation was the wrong positioning of surgical operations in 2 cases, dissociate nucleus missing in 1, nucleus further away in 1, detained again highlight in 2, only removing nucleus but no deal with lateral recess narrow in 5. After an average of 13 months (8 to 20 months) follow-up, assessed by the Nakai standard, the result was excellent in 7 cases, good in 3 cases, fair in 1 case.Conclusion: MED surgery should follow the principle that decompression should base on nerve center root. Recurrence after surgery is related to improper indications choice, positioning errors and surgical techniques, but satisfactory efficacy can be achieved through further surgery.