PELD在腰椎间盘突出症术后复发再手术中的疗效分析*

Analysis of the efficacy of PELD in the recurrence and reoperation of postoperative lumbar disc herniation *

摘要:

目的:探讨PELD在腰椎间盘突出症术后复发再手术的疗效。方法:回顾性分析2015年4月-2018年6月因腰椎间盘突出症行PELD手术复发病例12例，这些患者再次选择PELD手术治疗。采用改良MacNab优良率评价再次手术患者临床优良率，采用VAS评价患者症状改善情况，采用ODI评分观察患者的术后功能。记录患者的手术相关的并发症及再次复发情况。分析术后再次突出与患者BMI、吸烟史、年龄、突出类型、术后活动强度的相关性。结果:术后随访6-24月，改良MacNab优良率81%；术后末次随访VAS、ODI评分明显低于术前。术后再次突出与患者的BMI，术后活动强度有统计学差异，与吸烟史、年龄、突出类型无统计学差异;术中发生硬脊膜撕裂导致脑脊液漏1例，术后1月再次复发1例；未发现明显的残留、椎间隙下降、椎间不稳定、神经损伤、感染、血肿等并发症。讨论:PELD术后再次突出通常发生在术后10个月左右；且BMI较大、术后活动强度较高易引起再次突出，通过临床实践证明再次突出选择PELD手术可以达到满意的临床疗效。

Abstract:

Objective: TO investigate the efficacy of PELD in the recurrence and reoperation of postoperative lumbar disc herniation.Methods: A retrospective analysis was performed on 11 patients with recurrence of PELD surgery for lumbar disc herniation from April 2015 to June 2018. These patients again chose PELD surgery for treatment.Improved MacNab excellent and good rate was used to evaluate the clinical excellent and good rate of patients undergoing reoperation, VAS was used to evaluate the improvement of patients' symptoms, and ODI score was used to observe the postoperative function of patients.Surgical complications and recurrence were recorded.The correlation between postoperative remission and BMI, smoking history, age, type of remission and postoperative activity intensity was analyzed.Results: After 6-24 months of follow-up, 81% of the improved MacNab were excellent and good.The VAS and ODI scores in the last postoperative follow-up were significantly lower than those before surgery.There was a statistical difference in postoperative activity intensity between patients with postoperative re-herniation and BMI, but no statistical difference in smoking history, age and herniation type.One case of cerebrospinal fluid leakage caused by intraoperative rupture of dural membrane, and one case of recurrence 1 month after surgery;No obvious residual, decreased intervertebral space, intervertebral instability, nerve injury, infection, hematoma and other complications were found.Discussion:Postoperative re-herniation of PELD usually occurs about 10 months after surgery;In addition, higher BMI and higher postoperative activity intensity are likely to cause re-prominence, and it has been proved through clinical practice that the selection of PELD surgery for re-prominence can achieve satisfactory clinical efficacy.