腰椎间盘切除术后远期复发再手术的临床特点与治疗效果观察

Clinical characteristics and efficacy of long-term revision surgery for later recurrent lumbar disc herniation after primary lumbar discectomy

中文关键词:  腰椎间盘切除术  复发  手术  效果

英文关键词:Lumbar discectomy  Recurrence  Operation  Effectiveness

中文摘要:

  【摘要】　目的：探讨和评价腰椎间盘切除术后远期复发患者再手术的临床特点及治疗效果。方法：回顾性分析我科自2001年3月至2008年2月诊断为腰椎间盘切除术后复发且复发距首次手术时间超过5年的35例患者临床资料。其中男25例，女10例；平均年龄57.7岁（45~68岁）；病变节段分布为L3/4 3例，L4/5 22例，L5/S1 10例，平均复发时间8.7年（5.5~29年）。记录该组患者的一般资料和再手术术前的影像学资料，应用腰椎JOA评分和患者主观满意度评价手术的治疗效果。结果：35例患者均获得2年以上随访，平均随访时间4.7年（2~8年）；首次间盘切除手术中单纯开窗5例，半椎板切除8例，全椎板切除22例；再次翻修手术行单纯椎间盘切除2例，腰椎后路融合术（PLF）17例，腰椎后路椎间融合术（PLIF）8例，经关节突椎间盘切除椎间融合术（TLIF）8例；再次手术前影像学检查脊柱矢状位不稳定21例，病变间隙塌陷30例，腰椎前凸减少或后凸29例，MODIC改变24例。再次术前平均腰椎JOA评分11.8分，术后平均为20.4分（P<0.05），主观满意度优14例，良17例，中4例。再次术中发生脑脊液漏4例，术后出现伤口积液3例，无神经损伤等严重并发症出现。结论：腰椎间盘切除术后远期复发患者中腰椎矢状位曲线异常有较高的发生率，选择合适的手术方式可以获得较好的临床效果。

英文摘要:

  【Abstract】　Objective：To evaluate the clinical characteristics and efficacy of long-term revision surgery for later recurrent lumbar disc herniation after discectomy.Method：35 cases with recurrent lumbar disc herniation of more than 5 years after primary discectomy who were treated from March 2001 to February 2008 were retrospective reviewed.There were 25 males and 10 females with the average age of 57.7 years old（range，45 to 68 years）.The surgical segments included L3/4 in 3 cases，L4/5 in 22 cases and L5/S1 in 10 cases.The mean period between primary surgery and recurrence was 8.7 years（range，5.5 years to 29 years）.The demographic and imaging data before and after operation were recorded.Prolo lumbar score and patient subjective satisfaction were used to evaluate the effect of reoperation and the related factors of recurrence were analyzed.Result：All 35 patients were followed up for at least 2 years with the mean follow-up of 4.7 years（range，2 years to 8 years）.The surgical approach for primary discectomy included fenestration in 5 cases，semi-laminectomy in 8 cases and laminectomy in 22 cases，and the revision surgical approach was discectomy in 2 cases，PLF in 17 patients，PLIF in 8 patients and TLIF in 8 cases.During follow-up，the spinal sagittal imbalance was evident in 21 cases，30 patients had subsidence of intervertebral height，29 cases developed lumbar kyphosis or decrease of lordosis and 24 patients showed MODIC change.The average JOA score was 11.8 before operation and 20.4 after operation（P<0.05）.Subjective satisfaction was excellent in 14 patients，good in 17，and fair in 4 cases.4 cases were complicated with cerebrospinal leakage and 3 cases with wound hydrops.No neurological deficit was noted.Conclusion：Patients with later recurrent lumbar disc herniation after primary lumbar discectomy are apt to develop lumbar sagittal imbalance.Appropriate surgical approach can ensure a good outcome.