腰椎间盘突出症再手术治疗

目的探讨腰椎间盘突出症术后再次手术治疗的原因、方法和疗效.方法我院自1995年1月～2004年1月共手术治疗腰椎间盘突出症928例,再次手术者43例(4.6%).40例获得随访,平均随访时间30个月(3～84个月).按Macnab评分法进行术后疗效评定.结果优:11例(27.5%)、良:16例(40%)、可:8例(20%)、差:5例(12.5%).结论腰椎间盘突出症再次手术的主要原因为间盘组织摘除不彻底,同一间隙间盘组织再突出、继发性椎管狭窄以及神经根粘连等;腰椎间盘突出症初次手术前严格把握手术指征,正确选择手术术式,提高手术操作技术水平,将有效减少腰椎间盘突出症的再次手术治疗;对需要再次手术的患者仍可以获得较为满意的疗效.

Reoperative treatment of lumbar disc herniation

Objective To explore the causes, methods and outcomes of reoperative treatment after lumbar disc surgery. Methods Nine hundred and twenty eight patients with lumbar disc herniation were treated surgically from January 1995 to January 2004, of whom 43 patients(4.6%)underwent re-operation due to persistent pain or recurrence of symptoms. Forty patients were followed up from 3 months to 84 months(mean 30 months). Results According to Macnab's criteria, outcomes were excellent in 11 cases(27.5%), good in 16 cases(40%), fair in 8 cases(20%), and poor in 5 cases (12.5%). Conclusions The major causes of reoperation after lumbar disc surgery included incomplete removal of herniating discs and recurrent disc herniation of primary interspace, secondary lumbar canal stenosis, and adhesion of nerve roots. Prior to primary surgical treatment of lumbar disc herniation, operative indications must be strictly accurate, surgical methods should be correctly selected, and improved and refined surgical skills should be guaranteed. Satisfactory outcomes can be gained with reoperation for patients who still requiring treatment.