老年人慢性腰腿痛病因分析及临床治疗

目的探讨老年慢性腰腿痛的常见病因及其治疗。方法选择1997年1月至2000年12月间162例老年慢性腰腿痛患者，椎间盘突出92例（其中合并腰椎管狭窄者63例），单纯腰椎管狭窄10例，腰椎峡部裂或滑脱者37例，骨质疏松者23例。结果47例患者经保守治疗后出院，但其中18例症状复发。115例患者行手术治疗，其中椎板间扩大开窗或半椎板切除髓核摘除75例，全椎板切除髓核摘除9例，单纯峡部植骨术8例，脊柱内固定者23例。97例手术患者获得随访，平均18个月，症状消失或明显缓解者65例，残留部分症状者29例，无改善者3例。结论脊柱退行性变是导致老年人慢性腰腿痛的主要原因，以腰椎间盘突出和椎管狭窄为主，治疗上先予保守治疗，效果差时可积极手术治疗。

Etiological Analysis and Clinical Therapy of Senile Chronic Pain of Waist and Leg

ObjectiveTo explore the common etiological factors and therapy of senile chronic pain of waist and leg. Methods162 cases of senile chronic pain of waist and leg, between 1997.1 to 2000.12, were studied, including 92 cases of lumbar disc herniation, 73 cases of lumbar spinal stenosis(63 of them companied by lumbar disc herniation), 37 cases of lumbar spondylolysis or spondylolisthesis and 23 cases of osteoporosis. Results47 cases discharged after conservative therapy,while 18 of them relapsed. 115 cases received operation, including 75 cases of enlarged fenestration or half vertebral lamina resection with extirpation of nucleus pulposus, 9 cases of total vertebral lamina resection with extirpation of nucleus pulposus, 8 cases of simple bone replantation on spondylolysis and 23 cases of intemal fixation. 97 cases of operation received follow-up(average 18 months), finding that symptoms disappeared or moderated significantly in 65 cases, moderated partly in 29 cases and no amelioration in 3 cases. ConclusionSpine degeneration is the main cause leading to senile chronic pain of waist and leg, conservative therapy should be first and then operation may be regarded if the results were bad.