腰椎间盘突出症的再手术问题

本文报告16年手术治疗腰椎间盘突出症431例,再手术18例,再手术率4.17％。分析其原因有:术中马尾神经损伤3列;原椎间盘摘除不彻底3例。定位失误及双间隙突出造成椎间盘遗漏4例;术后外伤再复发4例;术后严重粘连、疤痕压迫脊髓造成严重症状者4例。主张在腰椎间盘突出症手术中应用硬膜外麻醉,反对片面强调小切口,强调准确定位及术后引流。腰椎间盘突出症再手术难度较大,应慎重考虑,必要时可经椎管造影或CT检查明确手术指征。

The Problem of Reoperation for Hemiated Lumbar Intervertebral Disc

431 cases suffered from herniated lumbar intervertebral disc were operated during past 16 years,a-mong them 18 cases were reoperated accounting for 4. 17%. The causes were. 1. damage of cauda equina during the first operation in 3 cases; 2. residue of the disc in 3 cases;3. failure in location or two levels of herniated disc leading to miss the herniated disc in 4 cases; 4. reherniation as a result of trauma after operation in 4 cases;5. serious disorders of lower spinal cord and cauda equina by serious compression of cicatrix and adhesion in 4 cases. Authors appreciate to make the decision of reoperation carefully. Myelography and CT can be used to verify the indication of reoperation.