老年性腰椎间盘突出症的临床特征:108例回顾性分析

Clinical features of the senile patients with lumbar intervertebral disc protrusion:retrospective analysis of 108 cases

目的:探讨老年性腰椎间盘突出症的发病机制、临床表现、治疗机制和疗效。方法:回顾性分析224例患者的临床资料。①用手法触诊检查确定腰椎棘突偏歪方向。②X射线腰椎正侧位片及CT或MRI检查。③应用冯氏手法治疗老年性患者108例和中青年患者116例,进行二者疗效对比。结果:老年患者共发现238个节段突出,L4～5和L5～S1椎间盘突出个数最多(169个,71%),多间隙突出86例(54.6%),变窄和未变窄的椎间隙发生椎间盘突出个数比较,差异有非常显著性意义(P<0.01)。老年和青壮年腰椎间盘突出症的手法治愈例数相比,差异有非常显著性意义(P<0.01),有效例数相比,差异无显著性意义(P>0.05)。结论:老年性腰椎间盘突出的病理变化主要是椎骨小关节的错位,压迫和牵拉了相应的组织。非手术治疗的关键是纠正小关节的错位和恢复脊柱的内外平衡因素。确诊靠CT或MRI检查。

AIM:To study the pathogenesis,clinical manifestation,treatment mechanism and the effect of senile lumbar intervertebral disc protrusion(LIDP). METHODS:The data of 224 cases were retrospectively analyzed:① The deviation of spinous process with lumbar vertebra was made with manipulative palpation.② The examination of X ray in the lateral view of lumbar spine and CT or MRI were pertormed. ③ A spinal palpation of Feng's spinal manipulation(FSM) treatment were applied for treating the deviation of 108 senile patients and 116 middle and young patients with LIDP,and the effects of the two methods were compared. RESULTS:There were 238 segments involved in all senile patients with L4-5 and L5-S1 segments mostly affected(169 segments,71%).There were 86 cases of multiple disc protrusion(54.6%).The number of LIDP in narrow intervertebral space and normal intervertebral space was compared,and there was a significant difference between them(P< 0.01).The healing number of middle and young aged patients with LDP with FSM treatment method and the senile patients were compared,and there was a significant difference between them(P< 0.01).There was no significant difference between their effective cases(P >0.05). CONCLUSION:The pathological changes of LIDP of senile patients are largely due to the displacement, compressing and stretching on corresponding tissues of vertebral small joints.The correction of vertebral subluxation and balance restore of spinal column are the key point in the conservative treatment.A precise diagnosis of the disease is mainly relied on CT or MRI examination.