腰椎间盘切除术后纤维环修复的研究进展
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1.山东第一医科大学(山东省医科院);2.曹县人民医院;3.山东第一医科大学第一附属医院骨科

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Research progress of annulus fibrosus repair after lumbar discectomy
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1.Shandong First Medical University(Shandong Academy Of Medical Sciences);2.Cao County People&3.amp;4.#39;5.&6.s Hospital

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    摘要:

    腰椎间盘切除术后髓核再突出(postoperation relapse of lumbar disc herniation, prLDH)压迫神经易引发腰椎术后综合征(failed back surgery syndrome, FBSS)。由于纤维环的供血主要来自周围节段性动脉分支的小血管,纤维环裂口瘢痕形成多需3-6个月。破口处形成的新瘢痕强度较低,当椎间盘内压力极速增加时,残余髓核多会从瘢痕处再次突出。同时由于椎管内的炎性因子通过纤维环破口进入椎间盘,进一步加重了椎间盘的退变。研究报道,纤维环修复能够促进破口瘢痕的愈合,明显增强瘢痕的硬度,降低髓核再突出率,减少了术后翻修的可能。随着脊柱外科微创化理念的流行,现纤维环修复的方式逐渐从开放式椎板开窗手术转变为内镜微创手术。因此,本文就不同术式下行纤维环修复作一综述。

    Abstract:

    Postoperation relapse of lumbar disc herniation (prLDH) compressions of lumbar nerves are prone to cause failed back surgery syndrome (FBSS). Because the blood supply to the annulus is mainly from the small vessels of the peripheral segmental artery branches, the formation of annulus scar takes 3-6 months. The intensity of the new scar formed at the rupture is low. When the pressure in the intervertebral disc increases rapidly, the residual nucleus pulposus will protrude again from the scar. At the same time, the inflammatory factors in the spinal canal enter the intervertebral disc through the annulus fibrosus rupture, which further aggravates the degeneration of the intervertebral disc. It has been reported that annular fiber repair can promote the healing of lacerated scar, significantly enhance the hardness of scar, reduce the re-protrusion rate of nucleus pulposus, and reduce the possibility of postoperative revision. With the popularity of the concept of minimally invasive spine surgery, the current way of fibrous ring repair has gradually changed from open laminae fenestration surgery to endoscopic minimally invasive surgery. Therefore, this paper reviews the different surgical procedures for descending annular fiber repair.

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  • 收稿日期:2022-12-06
  • 最后修改日期:2023-03-08
  • 录用日期:2023-04-11
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