腰椎间盘突出症手术失败的再手术治疗

目的:本文报告20例腰椎间盘突出症手术失败再手术的病人,目的在于分析手术失败的原因和再手治疗的有关问题。方法:回顾1989年至1996年间的1218例腰椎间盘突出症手术病人,选择其中20例因初次手术失败而接受再次手术的病人,对其再手术的原因和手术治疗进行回顾性研究。结果:初次手术失败的原因主要是突出间盘切除不全和术后发生疤痕性椎管狭窄,另外,马尾损伤、腰椎骨质增生、软骨板破裂及腰骶神经节椎管内异位畸形等亦是手术失败的原因。结论:作者强调首次手术应采用开窗术进行椎管减压和髓核摘除。再次手术难度较大,但病变显露应从正常解剖部位开始,仔细地去除疤痕和其它致病因素,以免神经根或神经组织的损伤。

Reoperative Intervention of Failure of lumbar surgery for Disc Herniation

Objective We reported 20 patients who underwent reoperative treatment of failure of lumbar surgery for disc herniation.in order to analyze the causes and surgical intervention of these failed back surgery syndrome,Method:Twenty individuals who had reoeration for failed lumbar disc surgery were selected and reviewed for study from!218 patients who underwent lumbar surgery for disc herniation from 89 to 1996-Result :The causes for failure of the initial operation were mainly due to insufficient removal oftihe herniated disc and secondary lumbar stenosis with scar,in addition,injury of cauda equina,osteo-phytes of lumbar spine,reputure of the carilaginous end plate,ectopic deformity of lumbosacral dorsal root ganglion within the spinal canal were also the causes of the failed lumbar surgery. 94. 4% of the patients dttained excellent and good results after'roperative treatment. Conclusion:The authors emhaised that the decompression of lumbar spinal canal and excision of herniated lumbar disc should be performed efectively through laminal fene straton in the initial operation. It is difficult for the reoperation to be performed,but the exposure to pathological site should be started carefully from normal site adjucent to scarred area. All of the pathogenic factors should be romoved completelly in order to avoid the injury of the neural elements.