腰椎间盘切除术后纤维环修复的研究进展

Research progress in annulus fibrosus repair after lumbar discectomy

摘要:

腰椎间盘切除术后髓核再突出（postoperative relapse of lumbar disc herniation, rLDH）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。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，减少术后翻修的可能。随着脊柱外科微创化理念的流行，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:

Postoperative relapse of lumbar disc herniation (rLDH) might compress nerves and 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 and the forma- tion of annulus scar takes 3~6 months, the new scar formed around the rupture has low strength-resistance capacity. As the pressure in the intervertebral disc increases rapidly, the residual nucleus pulposus will protrude again from the scar. On the other hand, the inflammatory factors released from the spinal canal into intervertebral disc through the annulus fibrosus rupture, and further aggravates the degeneration of the intervertebral disc. Fibrous ring repair can promote the healing of broken annulus fibrosus, 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 con- cept of minimally invasive spine surgery, the way of fibrous annulus repair has gradually changed from open laminae fenestration surgery to endoscopic minimally invasive surgery. Therefore, this paper reviews the different surgical procedures for annular fibrosus repair.