老年腰椎间盘突出症的临床特点及手术治疗

目的 探讨老年腰椎间盘突出症的临床特点和手术疗效.方法 回顾性分析30例老年腰椎间盘突出症的临床资料.其中男17例,女13例,年龄62～77岁,平均年龄69.1岁.并发高血压病8例、糖尿病7例、心脏病4例.小切口开窗髓核摘除19例,半椎板切除髓核摘除9例,多点开窗减压后路固定植骨融合术2例.采用JOA评分评价手术疗效.结果 手术均安全完成.平均随访2年1个月,术后JOA评分平均改善率69.1%.结论 老年腰椎间盘突出症患者内科并存症多,多节段退变和椎管狭窄者多.正确处理内科并存症,结合症状、体征、影像学及术中探查情况恰当减压,能获得较好手术疗效.

Characteristics and surgical treatment of lumbar intervertebral disc herniation in the elderly patients

Objective To investigate the clinical characteristics and surgical treatment of lumbar lntervertebral disc herniation （LDH） in the elderly patients. Methods The clinical data of 30 patients （17 males, 13 females） with LDH were retrospectively analysed. The mean age was 69.1 years （range, 62-77 years）. Of their complications, 8 cases sustained hypertension, 7 cases diabetes, and 4 cases cardiopathy. Among them, 19 cases were performed with minimal fenestration and nucleus pulposus resection, 9 cases with semi-laminectomy and nucleus pulposus resection, and 2 cases with multiple fenestration combined with posterior fixation and grafting fusion. Results All procedures were safely completed. The mean follow-up perrod was 2 years and 1 month. Postoperative JOA improvement rate was 69.1%. Conclusions Coexisting internal diseases, multi-segment degeneration and lumbar spinal stenosis are commonly seen in elderly cases with lumbar intervertebral disc herniation. A good therapeutic effect can be achieved through proper treatment of internal diseases, and proper decompression according to symptoms, signs, imaging and intra-operative results.