摘要
目的探讨微创腰椎间盘镜下髓核摘除术(MED)后复发的原因和治疗方法。方法采用MED治疗的单节段腰椎间盘突出症患者术后症状复发73例。统计其症状复发的时间、原因及再次手术方式。结果MED治疗腰椎间盘突出症(LDH)术后复发平均时间为(5.6±2.3)个月。术后症状复发的原因:侧隐窝狭窄未解除33例(45.2%),原位突出14例(19.2%),游离型椎间盘突出未发现8例(11.0%),椎间盘炎8例(11.0%),相邻椎间盘突出5例(6.8%),术后腰椎不稳3例(4.1%),神经根粘连2例(2.7%)。再次手术方式:MED 8例,椎板开窗髓核摘除术29例,半椎板切除神经根减压术21例,半椎板切除、横突间融合单侧椎弓根螺丝钉固定术4例,全椎板切除、椎间植骨融合内固定术3例,前路椎间盘摘除植骨融合术7例,前路椎间盘摘除术1例。前3种术式占再次手术总数的79.5%。结论MED治疗LDH术后复发时间一般在术后6个月左右。复发的主要原因是合并侧隐窝狭窄未解除和摘除椎间盘不彻底致原位突出。MED治疗LDH术后复发多数可采用MED、椎板开窗或半椎板切除髓核摘除术等方法治疗。
Objective To explore the efficacy of microendoscopic discectomy （MED）for the treatment of lumbar disc herniation （LDH） and the causes and treatment of recurrent herniation after MED. Methods Seventy-three cases with symptoms of recurrent low back and/or leg pain after primary surgical treatment with MED for single-segmented LDH were included in this study. The re- current time,the causes of the recurrences and the treatment modalities for the recurrences were statistically evaluated. Results The mean time of recurrence was 5.6 ~ 2.3 months（7days-8 months）. The causes for the recurrences included the following：fail- ures of decompression of the lateral recess stenosis （33 cases,45.20~ ） ,incomplete removal of herniated material that resulted in in situ hernia tions of the operated discs （14 cases, 19.2~ ）, failures in finding free fragments （8 case~＇l I ~ ）, adjacent herniations （5 cases, 6.8 ~ ）, discitis （8 cases, 11 ~ ）, instability of the lumbar spine after surgery（3 cases, 4.1 ~fro ）, and postoperative adhesions of the nerve roots （2 cases,2.7 ~//0 ）. The treatment modalities included the following procedures：8 cases by MED; 29 cases by windo wing of lamina and discectorny; 21 cases by semilaminectomy and discectomy; 4 cases by semilaminectomy, discectomy,inter-trans- verse processes bone grafting and fixation with unilateral rod and pedicle screws; 3 cases by total laminectomy and intervertebral fusion and instrumentation; 7 cases by anterior discectomy and lumbar interbody fusion; and one case by anterior discectomy. The above mentioned former three procedures consisted of 79.5 ~ of the total reoperations. Conclusion The mean time of recurrence is about 6 months after MED for the treatment of LDH. The leading cause of recurrent lumbar disc herniations after MED is failure in decompression of associated lateral recess stenosis and incomplete removal of herniated disc material that result in recurrence of the same level. Most of the recurrences can be managed by MED,partial laminectomy or semilaminectomy and discectomy.
出处
《重庆医学》
CAS
CSCD
北大核心
2009年第20期2547-2549,共3页
Chongqing medicine
关键词
腰椎间盘突出症
复发性腰椎间盘突出症
MED
腰椎
椎间盘
lumbar disc herniation
recurrence of lumbar disc herniation
microinvasive endoscopic discectomy
lumbar vertebrae
intervertebral disc
