腰椎间盘突出并椎管狭窄症手术失误及再手术治疗

目的：通过分析腰椎间盘突出并椎管狭窄症病人的初次手术失误原因，以预防手术失误的发生，并提出再手术的注意事项。方法：对西安西京医院１９５５年１月～１９９３年１２月所有手术治疗的腰椎间盘突出及椎管狭窄症２２４２例进行复查、整理，其中再手术者９８例，４３例（其中外院转入２４例）因第一次手术失误，导致症状无明显好转，或进一步加重，或合并其它症状而需再手术治疗，对４３例进行回顾分析。结果：从４３例再手术的腰椎间盘突出并椎管狭窄病人分析中，发现初次手术失误原因主要为腰椎管狭窄未解除，多间隙间盘突出遗漏，术中未找到突出间盘，仅行减压术和髓核未取尽。４３例再手术病人取得良好效果，优良率达９５．３％。结论：（１）初次手术时要加强术前检查明确诊断，确立正确手术方案。术中应注意解决椎间盘突出及椎管狭窄问题，既不能遗漏椎间盘突出或未解除椎管狭窄，也不能扩大减压损伤。在处理椎间盘突出的同时又要注意解决脊柱稳定性，对并发症要及时处理。（２）二次手术时应从正常部位进入椎管后细心分离粘连，摘除突出的髓核和解除椎管狭窄，防止损伤硬膜、马尾神经和神经根。

Reoperative Treatment of Failed Initial Lumbar Operation for Disc Herniation and Spinal Stenosis

Purpose: To analyse the causes of the failed initial lumbar surgery for disc herniation and spinal canal stenosis. Method: Of the 98 patients, who underwent reoperative treatment for failed initail lumbar surgery of disc herniation with or without spinal canal stenosis at Xijing Hospital, 43 patients (including 24 transfered from other hospital), who had an unsatisfactory improvement or even deterioration, were selected for the study. Resuls: The causes for failure of the initail operation were mainly due to unadequate decompression, incorrect location of the herniated disc and insufficient removal of the nucleus gelatinosus. 95.3 % of the patients attained excellent and good results after reoperative treatment. Conclusions: A thorough and careful preoperative examination and an all_round operative plan are of crucial significance for the initial operation. In cases of lumbar disc herniation associated with stenosis, decompression procedure should be carried out concurrently. It is desirable to maintain the stability of the spinal column. The authors emphasized that the exposure should be started from the normal site adjacent to the scarred area and the neural elements should be carefully protected.