腰椎间盘突出症二次手术的原因分析及预防

目的探讨腰椎间盘突出症术后二次手术的原因,提出预防及治疗措施。方法对我院39例腰椎间盘突出症患者再手术进行回顾性分析,男30例,女9例;平均年龄55岁（19～70岁）。根据再次手术前的病史、查体、影像学检查结果,结合术中发现分析再手术原因。结果再手术原因：内固定位置不良（1例）、定位错误（2例）、原间隙再突出（5例）、侧隐窝狭窄未根除（10例）、腰椎术后节段性不稳（8例）、血肿压迫（5例）、脑脊液漏（3例）、术后瘢痕压迫（5例）;术后2年随访,症状消失者25例,部分改善者13例,无改善1例。结论熟知解剖及局部病理变化、术前仔细查体、详尽阅片、术中仔细操作、术后充分引流是避免二次手术的关键。

REASONS AND PREVENTIVE MEASURES FOR REOPERATION OF LUMBAR DISC HERNIATION

Objective To investigate the reasons for reoperation of lumbar disc herniation,and put forward the treatment and the preventive measures.Methods Retrospectively analyses 39 patients experienced reoperation for lumbar disc herniation,30 male and 9 female,average age 55 years（between 19 to 70）.Based on history before reoperation,laboratory examination,results of images and intraoperative findings,we analyzed the reasons for reoperation.Results Reasons for reoperation：malposition of fixation（1 case）,location error（2 cases）,re-herniation in situ（5 cases）,unradication of lateral recess stenosis（10 cases）,segmental instability post-operation（8 cases）,hematoma compression（5 cases）,cerebrospinal fluid leakage（3 cases）,scar compression（5 cases）.During 2 years follow-up,25 cases asymptomatic,13 cases alleviative,only 1 case with no improvement.Conclusion Familiar with anatomy and local pathological changes,careful physical examination preoperatively,detailed film-reading,carefully operating intraoperative,adequate drainageare post-operationare essential to avoid reoperation of lumbar disc herniation.