腰椎间盘突出症后路髓核摘除28例并发症分析

目的：探讨腰椎间盘突出症后路髓核摘除手术并发症的发生原因，并提出相关防治措施。方法：自1996年6月-2006年6月，我院共有326例腰椎间盘突出症行后路髓核摘除术，其中椎板间开窗290例，半椎板切除29例，全椎板切除7例。结果：有28例出现手术并发症，包括神经根损伤3例，硬脊膜损伤5例（其中脑脊液漏1例），硬膜外血肿1例，椎间隙感染2例，椎间隙定位错误2例，极外侧型突出遗漏2例，术后腰椎失稳7例，原间隙髓核再突出6例。结论：我们只要充分认识极外侧型腰椎间盘突出症的特点，熟悉腰神经根的形状及走行，术前全面查体并常规拍腰椎X片，结合影像学资料认真分析，合理选择手术适应症及手术方式；术中注意无菌操作、正确定位、仔细解剖、规范操作、取净髓核、严密止血、充分引流；术后加强管理，围手术期应用抗生素，以上并发症是可以避免的。

An Analysis of 28 Cases with Complications Following Posterior resection of Nucleus Pulposus of Lumbar Disc Herniation

Objective:To investigate the cause of complications of posterior open-resection of nucleus pulposus of lumbar disc herniation,and to apply the correlative measures of prevention and treatment. Methods:from June 1996 to June 2006,326 cases of posterior openresection of nucleus pulposus of lumbar disc herniation were reviewed,290 cases were done through fenestration,29 cases through semi-laminectomy,7 cases through total-laminectomy.Results: 28 cases of complications of surgery occurred,These complications consisted of 3 cases of damnification of lumbar anterior roots,5 cases of damnification of hard ridge theca(1 case of CSF leak),1 case of hematoma on hard ridge theca,2 cases of wrong intervertebral location,2 cases of intervertebral infection,2 cases of pretermission of extreme lateral Lumbar Disc herniation,7 cases of post-operation lumbar instability,6 cases of recurrence of Lumbar Disc herniation.Conclusions: All the complications above can be avoided.It is required that we fully realize the characteristics of Extreme lateral Lumbar Disc Herniation,know the shap and run of lumbar anterior roots well,give the patient a full-scale physical examination and a routine lumbar vertebra X-ray examination before the surgery,analyse the medical photograph materals carefully,select operating indication and operating-style correctly;pay attention to manipulation with asepsis in the operation,make fixed position exactly,anatomize carefully,get the nucleus pulposus clearly,stop bleeding tight,make full drain,strengthen the post-operation administration and apply antibiotic in the perioperative period.