三种术式治疗复发性腰椎间盘突出症的临床疗效分析

目的比较后路扩大开窗髓核摘除术、后路经椎间孔腰椎间融合术(transforaminal lumbar interbody fusion,TLIF)、后路腰椎间融合术(posterior lumbar interbody fusion,PLIF)三种术式治疗复发性腰椎间盘突出症的临床效果。方法 2005年5月至2012年6月收治并随访65例,其中行后路扩大开窗髓核摘除术(A组)12例、TLIF(B组)26例、PLIF(C组)27例。结果 A组和B组手术时间低于C组(P0.05),A组术中失血量少于B组和C组(P0.05)。术中硬脊膜撕裂3例(B组1例、C组2例),神经根损伤2例(B组1例、C组1例)。术后切口均Ⅰ期愈合。三组疼痛视觉模拟评分、Oswestry功能障碍指数评分和椎间隙高度末次随访时与术前比较差异均有统计学意义(P0.05)。术后并发症(A组腰椎失稳1例,B组和C组发生断钉各1例),B组和C组椎间均骨性融合,无假关节形成及腰椎失稳。结论三种术式均可获得满意疗效,相对而言,TLIF是较为安全理想的一种术式。

Clinical Effect Analysis of Three Different Surgical Procedures in Treating Recurrent Lumbar Disc Herniation

Objective To compare the surgical effect of revisional discectomy, transforaminal lumbar interbody fusion （ TLIF）, and posterior lumbar interbody fusion （PLIF） on the recurrent lumbar disc herniation （RLDH）. Methods From May 2005 to June 2012,65 patients with entire follow-up were diagnosed with RLDH and underwent three different surgical procedures, 12 cases underwent revisional discetomy （ group A）, 26 cases underwent TLIF （ group B） and 27 patients with PLIF （ group C）. Results The operation time of group A and B was lower than that of group C （ P 〈 0.05 ）. The estimated blood loss during operation of group A was lower than that of group B and group C（P〈 0.05）. There were 3 patients（ one in group B and two in group C） of dural tears and 2 patients（ one in group B and one in group C） of nerve root injuries during perioperative period. The incision all healed without infection. There were significant differences the improvement rate of visual analogue scale （VAS）, Oswestry disability index （ODI） and the intervertebral space height of the recurrent level when compared the preoperative value with the final follow-up value （ P 〈 0.05 ）. There were one case of lumbar segmental instability in group A, each one case of rupture of distal screws in group B and C. Solid fusion mass was obtained in group ＇B and C ,without any pseudar- throsis and instability. Conclusion All of the three surgical procedures are effective for RLDH, but revisional discectomy may leads to the loss of intervertebral space height and the occurrence of iatrogenic instability, and the surgical time of PLIF is more than TLIF. In comparison,TLIF is one of safe and ideal methods to treat RLDH.