老年腰椎间盘突出症的特点与手术治疗

目的:探讨老年腰椎间盘突出症的特点与手术治疗效果。方法:对98例老年腰椎间盘突出症患者的临床与病理特点进行分析。男55例,女43例,平均年龄65.7岁。均行腰椎后路椎板减压髓核摘除术,其中小切口开窗56例,半椎板切除32例,全椎板切除10例,根据手术前后JOA评分评价手术疗效。结果:老年腰椎间盘突出症病理以髓核组织的脱水,纤维环的破裂,小关节囊、周围韧带及软骨终板退变为主要特点。临床特点为下肢疼痛多发,腰部活动受限较多;双下肢神经系统检查肌力下降明显,生理反射改变明显。98例平均随访2.2年,JOA评分术后平均改善率为70.9%,手术前后JOA评分比较差异有显著性意义(P<0.05)。结论:老年腰椎间盘突出症患者病程长,体征多,病理改变明显,行腰椎后路椎板减压髓核摘除术,手术效果满意。

Characteristics and surgical outcomes of lumbar intervertebral disc herniations in the elderly

Objective:To study the characteristics and surgical treatment for lumbar intervertebral disc herniations in the elderly.Method:98 cases of lumbar intervertebral disc herniations,including 55 males and 43 females with the mean age of 65.7 years,underwent lumbar posterior approach,of these 56 cases with minimal windowing-incisions;32 cases with semi-laminectomy and 10 cases with omni-laminectomy were documented.The surgical results were evaluated with Japanese Orthopedic Association score(JOA score).Result:The pathological characteristics of lumbar intervertebral disc herniation in the elderly showed dehydrolysis of nucleus pulposus and higher rate of annular fibrosus rupture.Cataplasis of ligamentum capsulare and terminal lamella were also found.The clinical characteristics showed higher rates of pain in lower extremity and lumbar dysfunction,obviously change in muscle weakness and physio-reflect.98 cases were followed up and the average periode was 2.2 years.The increase rate of JOA score was 70.9%.Compared to pre-operation,there was a significant increase of JOA score postoperationly(P<0.05).Conclusion:Elderly cases with lumbar intervertebral disc herniations has long nature history and more physical signs,especially in pathological change.Surgery can ensure the satisfactory outcome.