老年腰椎间盘突出症120例手术治疗体会

[目的]探讨老年腰椎间盘突出症的临床特点及治疗效果.[方法]对2003 年9 月至2009年5 月手术治疗的120 例65 岁以上的老年腰椎间盘突出症临床资料进行回顾性分析.其中男58例,女62例,平均年龄69.8岁,包括半椎板切除,神经根管减压,突出髓核摘除17例,椎板间开窗减压加椎间关节内侧部分切除,侧隐窝扩大,神...

Surgical Treatment of 120 Elderly Patients with Lumbar Intervertebral Disc Protrusion

[Objective] To explore the clinical characteristics and therapeutic effect of senile lumbar disc herniation（LDH）. [Methods]The clinical data of 120 senile patients aged over 65 years old with LDH were retrospectively analyzed. All patients included 59 males and 62 females. The mean age was 69.8 years. Hem- ilaminectomy, nerve canal decompression and removal of nucleus pulposus were performed in 17 cases. Interla- mellar fenestration, partial resection of medial intervertebral joint, lateral recessus expansion, nerve canal de- compression and removal of nucleus pulposus were performed in 71 cases. Laminectomy was performed in 32 cases which were mostly complicated with obvious vertebral facet hyperplasia and cohesion or lumbar destabili- zation, and underwent laminectomy, decompression, internal fixation with pedicle screw and lateral bone graft or lumbar interbody fusion. According to the JOA scores before and after operation, the surgical effect was e- valuated. [Results] The patients were followed up from 6 months to 3.5 years with the average of 25 months. At 6 months, 92 patients were followed up, and the average improvement of postoperative JOA score was （85. 1± 13.4）%, and the excellent rate was 80.4 % （74/92）. At 12 months, 60 patients were followed up, and the average improvement of postoperative JOA score was （80.3 ± 11.1） %, and the excellent rate was 71. 7 % （43/60）. There was significant difference in JOA score between before and after operation（ P d0.05）. [Conclusion] Posterior unilateral or bilateral interlaminar fenestration of lumbar, discectomy and expansion of spinal canal and nerve canal for the treatment of elderly patients with lumbar intervertebral disc protrusion and lumbar spinal stenosis has good effect. For patients who are complicated with severe facet hyperplasia and una- ble to reserve facet processus or complicated by instablility of lumbar vertebrae, lumbar posterior decompres- sion, discectomy, internal fixation with pedicle screw and post lateral or lumbar interbody fusion has satisfac- tory efficacy.