复发性腰椎间盘突出症的再手术治疗

【目的】探讨复发性腰椎间盘突出症的原因及再手术治疗效果。【方法】本文总结复发性腰椎间盘突出再手术治疗31例。初次手术治疗方式：胶原酶注射治疗6例，单纯腰间隙椎板开窗12例（包括MED髓核摘除5例，半椎板切除8例，全椎板切除5例）。再次手术方式：采用扩大开窗或半椎板切除4例，全椎板切除7例，对于腰椎不稳摘除髓核的同时采用椎弓根螺钉内固定＋椎间植骨或横突间植骨19例。【结果】本组病例经过术后12-36个月（平均18个月）的随访，患者未再次发生腰腿痛的症状，椎间植骨均达到临床骨性融合，术前对比术后2周VAS评分及X线椎间隙的高度有明显改善（P〈0．05），术后2年对比术后2周差异无显著性（P〉0．05）。【结论】对于复发性腰椎间盘突出症仔细分析原因，采用正确的术式，再手术治疗的效果是肯定的。

Reoperation of Recurrent Lumbar Disc Herniation

[Objective]To investigate the reoperation of recurrent lumbar disc herniation. [Methods] The clinical data of 31 cases of recurrent lumbar disc herniation were reviewed. The type of first operation included that 6 cases received collagenase injection, 5 cases underwent MED,8 cases underwent unilateral hemilamineetomy and 5 cases underwent total laminectomy. And 19 cases of lumbar instability were operated by screw fixation and interbody fusion or posterolateral fusion. [Results]A retrospective analysis on surgical treatment of 31 cases of recurrent lumbar disc herniation was acquired by 12- 36 months follow-up （at average of 18 months）. The symptom of baekleg pain after first operation had no recurrence and the graft was fused. The VAS and the height of interbody at 2 week after operation were significantly reduced （ P〈0.05）. There was no statistically significant difference between the 2 years and 2 weeks （ P〈0.05）. [Conclusion]The right operation can get satisfactory curative effect in recurrent lumbar disc herniation.