腰椎间盘突出症的再手术治疗

目的　探讨腰椎间盘突出症术后再手术治疗的原因、方法和疗效。　方法　 1993年 1月至2 0 0 0年 1月共手术治疗腰椎间盘突出症 76 4例 ,其中再手术者 42例 (5 5 % )。再手术方式为经原椎板间扩大开窗切除椎间盘 2 5例 ,半椎板切除减压椎间盘切除 6例 ,全椎板切除减压椎间盘切除 9例 ,前路经腹膜外椎间盘切除 2例。　结果　 42例均获得随访 ,随访时间 2 0月～ 81月 ,平均 5 2月。按Macnab疗效评定标准 ,优19例 (45 3% )、良 14例 (33 3% )、可 6例 (14 3% )、差 3例 (7 1% )。　结论　腰椎间盘突出症再手术主要原因为术后椎间盘突出复发 ,术前及术中突出节段定位错误 ,术后出现腰椎节段性不稳定以及合并神经根管狭窄、侧隐窝狭窄和中央椎管狭窄。如果再手术时机及再手术方式选择适当 ,腰椎间盘突出症的再手术治疗仍可以获得较为满意的疗效。

Reoperative treatment of lumbar disc herniation

Objective To explore the causes,methods and outcomes of reoperative treatment after lumbar disc surgery. Methods 764 patients with lumbar disc herniation were treated surgically from January 1993 to January 2000.Of whom there were 42 reoperated-on patients (5 5%).The surgical approaches taken in the second time included enlarged lamninotomy (25 cases),hemilaminactomy (6 cases),total laminactomy (9 cases) and anterior retroperitoneal approach (2 cases). Results All the 42 patients were followed-up for an average of 52 months (20 months to 81 months).According to the Macnab's criterion,the outcomes were excellent in 19 cases(45 3%),good in 14 cases (33 3%),fair in 6 cases (14 6%) and poor in 3 cases (7 1%). Conclusions The major causes of reoperation after lumbar disc surgery include recurrent disc herniation,wrong diagnosis and operation levels,postoperative segmental instability and the coexisting narrow and stenosis of nerve root canal,lateral recess and central spinal canal.If the time and surgical approaches are choosen suitably,statisfactory outcome can be gained with the reoperation management for patients who underwent the lumbar disc surgery previously.