腰椎间盘突出症术后原间隙再突出的病因分析和策略

目的回顾性分析临床确诊为腰椎间盘突出症并行单纯髓核摘除手术治疗证实的患者,术后2年内出现原手术间隙髓核再突出的临床资料,为一期手术时减少腰椎间盘手术失败综合症的发生提供参考。方法分析1995~2005年我科收治的患腰椎间盘突出症并行单纯髓核摘除的患者中,术后2年内发生原间隙髓核再突出的63例患者的临床表现,以及该患者第1次手术时的临床资料及手术方式。其中男41例,女22例。初次手术在我科进行的9例,于外院进行的54例。行椎间盘镜及小开窗手术者21例,半椎板及全椎板手术者42例。单间隙手术者51例,2个间隙及以上者12例。结果17例患者再次手术时仍采用单纯髓核摘除治愈,41例患者行后路椎管减压髓核摘除椎弓根螺丝钉内固定植骨融合术(PLIF),5例患者行经椎间孔髓核摘除椎弓根螺丝钉内固定植骨融合术(TLIF)。所有病例均于二次手术后治愈。结论腰椎间盘突出症手术后再突出是一临床常见的难题,不论早期和晚期均有可能发生,合理选择手术适应症及恰当的手术方式有利于减少再突出的发生,二次手术可获得临床治愈。

Analysis of the cause of recurrent lumbar disc herniation at the same level and its surgical strategy

Objective In order to provide a useful information for careful analysis of clinical data and decreasing the incidence of failed back surgery syndrome(FBSS) after primary surgery,the study aim to give a retrospective analysis of those patients,after being diagnosed lumbar disc herniation definitely,who developed recurrent lumbar disc herniation(RLDH) at the same level in 2 years of simple lumbar discectomy.Methods From 1995 to 2005,there were total 63 cases of recurrent lumbar disc herniation at the same level,41 males,33 females,treated primarily with simple lumbar discectomy.The study gave a retrospective analysis on clinical syndromes,clinical data and surgical modalities.At primary surgery,9 cases were treated in our hospital,54 cases were treated in other hospitals.Among these cases,21 treated with windowing and microdiscectomy,42 treated with total laminectomy and hemilaminectomy,and 51 cases were singel level surgery,12 cases were multiple levels surgery.Results All cases recovered well after re-operation: 17 cases treated with lumbar disc excision,41 cases treated with posterior lumbar interbody fusion(PLIF) technique,5 cases treated with transforminal lumbar interbody fusion(TLIF) technique.Conclusion RLDH is a tough clinical problem,it may occurre either at early stage or at late stage.Reasonably selecting surgical indication and properly surgical methods may decrease the incidence of recurrent lumbar disc herniation.Cases with RLDH may acquire clinical recovery when adopt secondary surgery.