CAJ | 학술논문

目的探讨腰椎间盘突出症再手术的原因及手术方式.方法自1999年5月至2007年3月再手术治疗腰椎间盘突出症患者37例,分析再手术原因.再手术方式:扩大开窗椎间盘摘除5例,半椎板切除减压6例,全椎板切除减压26例.21例行后路椎弓根螺钉内固定横突间植骨融合,其中11例同时行椎间融合.结果再手术原因为:同节段复发性突出13例(35.1%),相邻节段突出3例(8.1%),椎管、侧隐窝狭窄11例(29.7%),腰椎节段性不稳定7例(18.9%),椎弓根螺钉位置不佳2例(5.4%),定位错误1例(2.7%).随访1～7年,平均3.2年;按Macnab疗效评定标准,优11例,良17例,可7例,差2例,优良率为75.7%.结论腰椎间盘突出症再手术的主要原因是同节段复发性突出、继发性椎管狭窄、腰椎节段性不稳定等.正确分析再手术的原因,选择合理的手术方式及注意手术技巧,可使腰椎间盘突出症再手术获得较为满意的疗效.
목적 탐토요추간반돌출증재수술적원인급수술방식.방법 자1999년5월지2007년3월재수술치료요추간반돌출증환자37례,분석재수술원인.재수술방식:확대개창추간반적제5례,반추판절제감압6례,전추판절제감압26례.21례행후로추궁근라정내고정횡돌간식골융합,기중11례동시행추간융합.결과 재수술원인위:동절단복발성돌출13례(35.1%),상린절단돌출3례(8.1%),추관、측은와협착11례(29.7%),요추절단성불은정7례(18.9%),추궁근라정위치불가2례(5.4%),정위착오1례(2.7%).수방1～7년,평균3.2년;안Macnab료효평정표준,우11례,량17례,가7례,차2례,우량솔위75.7%.결론 요추간반돌출증재수술적주요원인시동절단복발성돌출、계발성추관협착、요추절단성불은정등.정학분석재수술적원인,선택합리적수술방식급주의수술기교,가사요추간반돌출증재수술획득교위만의적료효.
Objective To analyze the reasons and investigate the methods of reoperative treatment after lumbar disc surgery. Methods From May 1999 to March 2007, 37 cases were treated with reoperation after lumbar disc surgery. The reasons were analyzed.Five cases underwent enlarged laminectomy.Six cases did semi-laminectomy.Twenty-six cases did total laminectomy.Twenty-one cases did total laminectomy and transpedicular screw fixation and bone graft (diapophysis fusion for 21cases and interbody fusion for 11 cases simultaneous ). Results The reasons of reoperation included: recurrent lumbar disc herniation(13 cases), adjacent lumbar disc herniation(3 cases), spinal canal stenosis and lateral recess stenosis(11 cases), postoperative segmental instability(7 cases), mistaken implantation of transpedicular screw(2 cases), wrong intraoperative location (1 case). All patients were followed up from 1 year to 7 years (mean 3.2 years). According to macnab's criteria, outcomes were excellent in 11 cases, good in 17 cases, fair in 7 cases and poor in 2 cases. The excellent and good rate was 75.7%. Conclusion Recurrent lumbar disc herniation, postoperative segmental instability, spinal canal stenosis are the main reasons of reoperation. With a correct analysis of reoperative reasons, an appropriate method and fine surgical skills, reoperation can achieve satisfactory result.