腰椎间盘突出症后路开窗术后并发症分析

Analysis of Complications after Posterior Fenestration for Lumbar Disc Herniation

摘要: 目的：探讨腰椎间盘突出症后路开窗术后并发症成因及解决办法。方法：回顾性分析2014年2月~2015年2月间在我院骨科行后路开窗髓核摘除术、随访1年以上的28例腰椎间盘突出症患者临床资料，采用JOA评分，观察其术后近期及中期疗效。结果：术后随访1个月~3年(平均1.5年)，中期改善率为81.0%，优良率为89.3% (25/28)；远期改善率为85.7%，优良率为92.9% (26/28)。本组28例随访过程中6例(21.4%)发生硬脊膜、神经根黏连，5例(17.9%)出现原发节段椎间盘再突出，4例(14.3%)出现相邻节段椎间盘突出，2例(7.1%)出现腰椎节段性不稳定，1例(3.6%)发生继发性椎管狭窄。上述并发症均发生主要涉及患者局部瘢痕增生与腰椎生物学性状改变所引起的脊柱稳定性破坏。均经对症处理后好转。结论：腰椎间盘突出症后路开窗术疗效显著，但术后中、远期并发症发生率较高。术前应全面了解患者情况，综合查体、腰椎X片及相关影像资料，严格掌握患者手术适应症，合理选择正确的术式及入路，减少术后并发症的发生。

Abstract: Objective: To investigate the causes and solutions of complications after posterior fenestration of lumbar disc herniation. Methods: The clinical data of 28 patients with lumbar disc herniation who underwent nucleus pulposus removal in our hospital from February 2014 to February 2015 and followed up for more than 1 year were retrospectively analyzed. Using JOA grade, short-term and medium-term efficacy after surgery was observed. Results: All patients were followed up for 1 month to 3 years (mean 1.5 years). The medium-term improvement rate was 81.0%, the excellent and good rate was 89.3% (25/28), the long-term improvement rate was 85.7%, and the excellent and good rate was 92.9% (26/28). In this group of 28 patients, 6 patients (21.4%) had dural and nerve root adhesions, 5 patients (17.9%) had primary segmental disc re-protrusion, 4 patients (14.3%) had adjacent segmental intervertebral discs, 2 cases (7.1%) had lumbar segmental insta-bility, and 1 case (3.6%) had secondary spinal stenosis. All of the above complications occurred mainly related to the stability of the spine caused by local scar hyperplasia and changes in the bi-ological characteristics of the lumbar spine. All improved after symptomatic treatment. Conclusion: The posterior fenestration of lumbar disc herniation is effective, but the incidence of middle and long-term complications is higher. Before the operation, the patient should be fully informed about the situation, comprehensive examination of the body, lumbar X-ray and related imaging data, strict control of the patient's surgical indications, reasonable selection of the correct surgical procedure and approach, to reduce the occurrence of postoperative complications.