腰椎间盘突出再手术51例临床分析

目的:总结腰椎间盘手术失败综合征的原因,提出避免再次手术的主要措施。方法:对51例腰椎间盘突出再手术患者临床资料进行回顾性分析。结果:51例腰椎间盘突出症患者初次手术失败,主要原因:未找到髓核、髓核取出不彻底、腰椎间盘突出合并椎管狭窄松解不彻底及多间隙突出遗漏。再手术后随诊6个月～3年,优24例,良19例,可5例,差2例,垂足1例,优良率达84.31%。结论:严格掌握手术指征,术前进行充分准备,手术需要有经验的医师参与,手术方法正确选择可避免腰椎间突出症手术失败;术中操作应细致轻柔,避免过多剥离和破坏椎板结构,对失稳性腰椎间盘突出症手术减压的同时应行内固定及植骨治疗。

Study on reoperation of lumbar intervertebral disc herniation

Objective:To investigate the causes of reoperation of lumbar intervertebral disc herniation and find countermeasures.Methods:Clinical data of 51 patients who underwent reoperation of lumbar intervertebral disc herniation were retrospectively analyzed.Results:The main causes of initial operative failure of 51 patients with lumbar disc herniation included:failure of finding nucleus,incomplete removal of the nucleus,inappropriate management of the spinal stenosis coexisted with lumbar disc herniation,missed treatment of some multiple herniations.The good and very good rate of reoperation was 84.31% according to associated evaluation criteria and the follow-up of 6 months～3 years,including very good in 24 cases,good in 19 cases,less good in 5 cases and poor in 2 cases,1 patient with an involuntary mobile leg.Conclusion:Countermeasures for the prevention of operative failure of lumbar disc herniation include:strict indications,adequate preoperative preparation,experienced orthopedic surgeon,proper operative procedure;internal fixation and bone grafting should be performed for the patient with instable lumbar disc herniation at the same time of decompression.