老年人腰椎间盘突出症的病因和手术治疗(附46例报告)

PATHOGENESIS AND OPERATION OF LUMBAR DISC PROTRUTION IN SENILE PEOPLE

腰椎间盘突出症多见于青壮年。作者报告老年人腰椎间盘突出症46例,其中男性30例,女性16例,年龄60～68岁,平均64.2岁。本组病例均经CT/MRI及手术证实诊断。椎间盘突出部位最多发生在L_(4.5)及L_5S_1,与术前腰椎X线平片椎间隙狭窄平面基本一致。椎管/神经根管狭窄41例(89.1％),黄韧带增厚(>5mm)26例(56.5％),小关节肥大、内聚18例(39.1％)。对重症患者经短期非手术治疗无效后应尽早手术。术后1～7年,平均2年7个月,随访35例,优25例,良7例,优良率为91.4％,再手术率为2.8％(1/35)。作者认为老年腰椎间盘突出症病人均有腰椎退行性改变,绝大部多数合并椎管/侧隐窝狭窄,重视扩大椎管/神经根管是手术成功的关键。

Lumbar disc protrution appears commonly in young people. However, 46 senile patients with this illness are reported in this paper. 30 subjects were male and other 16 were female. Their mean age was 62. 4 years (from 60 to 68 years). Every diagnosis was verified by CT/MRI film and the operation. The lumbar disc protrution appeared generally in L4.5and L5S1 where stenosis of disc space usually could be seen in X-ay films. 41 cases(89.1%) were combined with stenosis of spinal canal or lateral recess, 26(56. 5%) with thickening of ligament flavum and 18(39. 1%) with hypertrophy of small joints. 35 cases had been followed up for 1 to 7 years (mean 2. 6 years). Among them, the result of 25 cases (74. 1%) was excellent, 7(20%) was good and one patients was re-operated. It is suggested that operation should be performed if non-operational treatment was invalid within a short time. The degenerative change of lumbar spine occured in these senile patients and stenosis of spinal canal or lateral recess could be found in most cases. Therefore, the dilatation of spianl canal or lateral recess is the key to the successful operation.