腰椎间盘突出症再手术原因分析

目的：分析腰椎间盘突出症再手术原因并探讨其治疗方法和疗效。方法：回顾性分析1998年1月至2006年1月手术治疗的腰椎间盘突出症175例，其中17例复发性腰椎间盘突出症需再手术治疗，17例中，男11例，女6例；年龄35-65岁，平均49岁。经原椎板间扩大开窗法切除椎间盘11例，全椎板切除减压椎间盘切除5例（同时行内固定＋后外侧植骨融合），单侧椎板切除1例。术后对患者的疼痛、运动功能、神经根受压表现进行观察，并根据Macnab标准对疗效进行评定。结果：17例均获随访，时间15-96个月，平均51个月。所有患者的疼痛、运动功能及神经根受压表现均有不同程度改善。按Macnab评定标准：优9例，良6例，可2例。结论：腰椎间盘突出症再次手术的主要原因为同一间隙闻盘组织再突出、继发性椎管狭窄、邻近椎间盘突出等。虽然腰椎间盘突出症再手术难度大于初次手术，但只要严格掌握手术指征，术前周密计划，仍可取得满意疗效。

The reasons for reoperation of lumbar disc herniation

Objective: To explore the causes,methods and outcomes of the reoperation after lumbar discectomy. Methods: One hundred and seventy-five patients with lumbar disc herniation were treated surgically from January 1998 to January 2006. Among them,17 patients with recurrent lumbar intervertebral disc herniation underwent reoperation,including 11 males and 6 females,with mean age of 49 years(range,35 to 65 years). The second operation for the recurrent disc herniation included enlarged laminactomy with discectomy in 11 cases,total laminactomy with discectomy followed by internal fixation and posterolateral grafting in 5 cases,hemilaminactomy with discectomy in 1 cases. The Macnab's criteria was used to evaluate therapeutic effect,the pain and motor function following the revision,as well as the signs of nerve root compression. Results: All the 17 patients were followed up for an average of 51 months(15 to 96 months). The pain,motor function and the sings of nerve root were improved to some extent after reoperation. The outcomes determined by Macnab's criteria was excellent in 9 cases,good in 6 cases,fair in 2 cases. Conclusion: The major causes of reoperation after lumbar discectomy are recurrent disc herniation from same disc level,secondary stenosis of lumbar spinal canal and disc herniation from levels next to the involved disc. Reoperation is more difficult than the primary discectomy,but the result is satisfactory if the proper indication and good preoperative planning are well performed.