腰椎椎间盘突出症再手术治疗的临床分析

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1、：Februar~2009．VOl8，No1·15·，2010年2月，第8·临床研究·腰椎椎问盘突出症再手术治疗的临床分析李忠海，马辉，赵杰，王聪，陈志明，张海龙，侯铁胜【摘要】目的总结腰椎椎问盘突出症再手术治疗的临床疗效。方法回顾总结2002年1月一2009年5月收治的78例采用腰椎单枚斜向融合器椎问融合、椎弓根螺钉内固定术治疗的腰椎椎问盘突出症再手术患者的临床资料，男48例，女30例；年龄为41～78岁，平均为62．4岁。术后应用Oswestry功能障碍指数(Oswestrydisabilityindex，ODI)、VAS评分及影像学检查对临

2、床疗效进行评价。结果手术时间平均150min(120～210min)。随访0．5～5年，平均3．9年。术后椎问隙高度得到明显恢复，末次随访高度未见明显丢失。VAS评分由术前的7．3±1．4减至末次随访时的2．2±0．6，ODI由术前的59．6％4-9．4％减至末次随访时的28．4％4-3．2％。在随访期间VAS评分及ODI均得到明显恢复，与术前相比差异有显著统计学意义(P<0．01)。结论腰椎椎间盘突出症再手术患者多伴有椎间隙狭窄和节段性失稳，其治疗需要兼顾减压和稳定两个方面，腰椎单枚斜向融合器椎体间融合术不失为一种较为理想的手术方式。【关键词】

3、腰椎；椎间盘移位；脊柱融合术；内固定器【中图分类号】R681．533【文献标志码】A【文章编号】1672—2957(2010)01—0015一o5ClinicalanalysisofreoperafiontolumbardischerniationL／Zhonghai，MAHui，ZHAO，WANGCong，CHENZhim—ing，ZHANGHailong，HOUT&sheng．DepartmentofOrthopaedics，ChanghaiHospital，SecondMilitaryMedicalUnive~ity，Shanghai200

4、433，China【Abstract】ObjectiveToexploretheclinicaloutcomesofreoperativetreatmentforlumbardischerniationafterstandarddisceetomy．MethodsFromJanuary2002toMay2009，78patientsunderwentreoperationwithposteriorlumbarinterbodyfusionusingonediagonalfusioncagewithtranspedicularscrew／rodfi

5、xation．Therewere48malesand30females．Theaver—ageageofthepatientswas62．4years(rangingfrom41to78years)．VASscoresandOswestrydisabilityindexwereusedtoassessclinicaloutcomes．Discheightandboneunionwereexamined．ResultsThetotaloperatingtimerangedfrom120to210minwithameantimeof150min．Al

6、lthecaseswerefollowedupforanaveragetimeof3．9years(rangingfrom0．5to5years)．Discspaceheightwasrestoredobviouslybythesurgeryandmaintainedatthelatestfollow—up．TheVASscoresreducedfrom7．3±1．4preoperativelyto2．2±0．6atthelatestfollow·up．andtheOswestrydisabilityindexreducedfrom59．6％±9

7、．4％preoperativelyto28．4％±3．2％atthelatestfollow—up．TheVASscoresandOswestrydisabilityindeximprovedobviously，andthereweresignificantstatisticdifferencebetweenpreoperativeandpostoperativedata(尸<0．01)．ConclusionPatientswhounderwentstandarddiscectomyforlumbardischerniationpreviousl

8、yhasparticularcharacterslikediscspacenarrowedandsegmentalinstability