腰椎椎间盘突出症复发因素分析及再手术治疗探究

目的探讨腰椎椎间盘突出症需要再次手术的原因及其相应治疗方法。方法选取在我院诊治的资料完整的腰椎椎间盘突出症再手术患者56例,回顾性分析其再次手术的原因及治疗措施,并进行归纳总结。结果 56例患者中,再次手术的原因为术中定位错误3例,椎间盘突出原位复发21例,内固定失败1例,遗漏相邻椎间盘多间隙突出10例,继发椎管狭窄6例,游离髓核清除不彻底9例,腰椎不稳6例;再手术方式为单纯开窗髓核摘除术7例,半椎板椎间盘切除术12例,全椎板椎间盘切除减压术5例,椎间盘切除植骨融合术29例,内固定3例,再手术后,症状均好转。结论腰椎间盘突出症需再次手术的原因为术中定位不准确、椎管继发狭窄或减压不充分、内固定失败、椎间盘突出复发、遗漏相邻间隙椎间盘突出等,再次手术可改善症状,取得较好疗效。

Exploration of reoperation factors and treatment strategies of lumbar disc herniation

Objective To analyze and explore the reoperation factors and treatment strategies of lumbar disc herniation.Methods The recurrence factors and the appropriate operational methods of 56 patients receiving lumbar disc herniation reoperation in our hospital were analyzed.Results The causes of the reoperation among 56 cases of patients were that 3 cases resulted from intraoperative positioning error,21 cases resulted from disc herniation in situ recurrence,1 case resulted from internal fixation failure,10 cases resulted from missing adjacent herniated disk,6 cases resulted from secondary onset spinal stenosis,9 cases resulted from incompletely clearing of free nucleus pulposus,6 cases resulted from lumbar spinal instability.7 cases were treated with simply open the window to nucleus pulposus enucleation,12 cases were treated with half lamina discectomy,5 cases were treated with omni-posterior decompression disc resection,29 cases were treated with disc resection and interbody fusion,3 cases were treated with internal fixation.After reoperation,symptoms all improved.Conclusion The reasons of lumbar disc herniation reoperation are intraoperative positioning error,secondary onset spinal stenosis,internal fixation failure and missing adjacent herniated disk.Reoperation can improve symptoms,achieve good effect.