腰椎间盘突出症再手术原因分析及对策

摘要

Objective By analyzing the main reasons of reoperation for lumbar disc heniation (LDH),to explore the relevant factors for LDH recurrence and the effect of posterior lumbar inter-body fusion (PLIF) and instrumentation. Methods Retrospective analysis was carried out in 216 patients with LDH who were treated surgically from August 2008 to June 2012,in which 39 pa-tients underwent reoperation (18.1%). The reasons of reoperation and the effects of PLIF and in-strumentation were analyzed. Results Local recurrence was the main reason for reoperation in 39 cases (89.7%),34 cases obtained good effects. The JOA score was significantly different between before and after operation (P<0.05). The excellent and good rate was 87.2%. Conclusion The op-eration indication of the LDH should be controlled strictly,and the herniated tissues should be wholly excised. With regard to the revision disectomy,by taking the proper manner of the operation, and raising the skills of the manipulation,fine results can be achieved. PLIF and instrumentation is an effective procedure for recurrence of LDH.%目的：通过分析腰椎间盘突出症再手术的主要原因，探讨其复发相关因素及椎管减压椎间植骨钉棒内固定为主要手术方式的临床效果。方法回顾我院2008-8-2012-6月手术治疗腰椎间盘突出症216例中再手术者39例（18.1％），分析再手术的原因及效果。结果原位复发35例（89.7％），是再手术最主要的原因,均行后路椎间融合器植入加椎弓根螺钉系统，34例手术效果优。手术前后JOA评分有显著性差异（P<0.05），优良率为87.2％。结论腰椎间盘突出症手术应严格掌握适应证，彻底摘除突出的组织，对可能突出的组织做相应处理。控制好再手术指征，提高操作技巧。后路减压融合内固定术治疗同间隙的复发腰椎间盘突出临床疗效满意。