Hanakita J, Suwa H, Nishihara K, Iihara K, Sakaida H, Nishi S
Department of Neurosurgery, Shizuoka General Hospital.
No Shinkei Geka. 1991 May;19(5):429-34.
Since 1983, the authors encountered 270 cases of lumbar disc hernia, which were operated on with the microsurgery. In the present study, the operative procedures were described and the results, especially the results of the reoperations were examined. Good results were obtained in 252 patients (93%). In nine patients, some kind of lumbago continued, which required other treatments, such as epidural block (3.3%). Reoperations were performed in nine patients (3.3%). In lumbar discectomy, extent of removal of the bony structures and the disc material seemed important. In "microlumbar discectomy", which was advocated by Williams, only the flavectomy with no bony structure removal was performed. In this procedure, discectomy is limited to the protruded disc material. On the contrary, some authors, who also adopt microsurgical lumbar discectomy as Wilson and Hudgins do, perform subtotal removal of the disc material with removal of some bony structures. In the present series, microsurgical lumbar discectomy following the procedures advocated by Wilson et al was performed. Reoperations after lumbar discectomy have been reported after all kinds of operations. In the present series, the rate of reoperation was 3.3%. As to the reasons for reoperations, true recurrence of disc hernia was the most prevalent. The hernias recurred at the same level and on the same side. Adhesion or fibrosis around the nerve root also played an important role. From the results of the present study, microsurgical lumbar discectomy with good illumination and high magnification has proved to bring satisfactory results. Recurrence, however, can occur after this procedure, so further inventions are required to ensure more satisfactory results.
自1983年以来，作者共收治270例腰椎间盘突出症患者，并对其进行了显微手术治疗。在本研究中，描述了手术步骤，并对手术结果，尤其是再次手术的结果进行了检查。252例患者（93%）取得了良好的效果。9例患者仍有某种程度的腰痛，需要其他治疗，如硬膜外阻滞（3.3%）。9例患者（3.3%）进行了再次手术。在腰椎间盘切除术时，骨质结构和椎间盘组织的切除范围似乎很重要。Williams提倡的“显微腰椎间盘切除术”仅进行黄韧带切除术，不切除骨质结构。在此手术中，椎间盘切除术仅限于突出的椎间盘组织。相反，一些作者，如Wilson和Hudgins，他们也采用显微腰椎间盘切除术，在切除一些骨质结构的同时，对椎间盘组织进行次全切除。在本系列研究中，采用了Wilson等人提倡的显微腰椎间盘切除手术方法。各种腰椎间盘切除术后均有再次手术的报道。在本系列研究中，再次手术率为3.3%。关于再次手术的原因，椎间盘突出症的真正复发最为常见。突出在同一节段的同一侧复发。神经根周围的粘连或纤维化也起重要作用。从本研究结果来看，具有良好照明和高放大倍数的显微腰椎间盘切除术已被证明能带来满意的效果。然而，此手术后仍可能发生复发，因此需要进一步改进以确保更满意的结果。
