摘要
【目的】探讨腰椎间盘突出症的复发因素及手术疗效。【方法】自2006年6月至2011年12月手术治疗腰椎间盘突出症328例，其中复发性腰椎间盘突出再手术治疗26例（其中外院转来¨例）。该26例初次手术治疗方式：①胶原酶注射治疗4例，②单纯椎板开窗及半椎板切除22例（包括MED髓核摘除6倒，半椎板切除10例，全椎板切除6例）。原手术部位：L3H5例，L4／5 13例，k／S18例。再次手术方式：采用扩大开窗或半椎板切除4例，全椎板切除7例，对于腰椎不稳摘除髓核的同时采用椎弓根螺钉内固定＋椎间植骨或横突间植骨15例。再次手术前均作动态X线片，CT或MRI影像检查。【结果】本组病例经过术后12～36个月（平均18个月）的随访，患者未再次发生腰腿痛的症状，椎间植骨均达到，晦床骨性融合，与术前对比术后2周VAS评分及x线椎间隙的高度有明显改善（P〈0．05），术后2年对比术后2周差异无显著性（P〉0．05）。【结论】对于复发性腰椎间盘突出症仔细分析原因，采用正确的术式，再手术治疗的效果是肯定的。
[Objective]To explore the recurrence factors and surgical efficacy of lumbar intervertebral disc herniation. [Methods]Totally 328 patients with lumbar intervertebral disc herniation from June 2006 to Dec. 2011 underwent surgical treatment. Among them, 26 patients with recurrent lumbar intervertebral disc hernia- tion including 11 patients from hospital referral underwent reoperation. The initial methods of 26 patients in- eluded 4 cases of collagenase injection and 22 cases of simple vertebral lamina fenestration and semi-laminecto- my（6 cases of MED disectomy, 10 cases of semi-laminectomy and 6 cases of total laminectomy）. Primary sur- gical sites included 5 cases of L3/4 , 13 cases of L4/5 and 8 cases of L5/S1. Reoperation methods included 4 cases of expanded fenestration or semi-laminectomy, 7 cases of total lamineetomy and 15 cases of lumbar instability with diseetomy, pedicle screw fixation and intervertebral bone graft or horizontal axon bone graft. Dynamic X- ray film, CT or MRI were performed before reoperation. [Results]No lumbar and leg pain in all patients oc- curred again after 12 - 86 months of follow up（mean 18 months）. Intervertebral bone graft achieved clinical bone fusion. Compared with be.fore treatment, VAS score and the height of intervertebral space by X-ray 2 weeks after operation were obviously improved（ P d0.05）. There was no significant difference in VAS score and the height of intervertebral space by X-ray between 2 years and 2 weeks after operation（ P 〉0.05）. [Conclusion]For recurrent lumbar intervertebral disc herniation, the cause should be carefully analyzed, and correct surgical methods should be taken. The efficacy of reoperation is certain.
出处
《医学临床研究》
CAS
2013年第2期330-332,共3页
Journal of Clinical Research
关键词
椎间盘移位
病因学
椎间盘移位
外科学
腰椎
外科学
intervertebral disk displacement/ET intervertebral disk displacement/SU
lumbar ver-tebrae/SU
