老年腰椎管狭窄伴下肢动脉硬化性闭塞症的诊治分析

Clinic valuation of concurrent lumbar spinal stenosis and arteriosclerolsive occlusion of low extremity in old people

目的探讨老年腰椎管狭窄症伴下肢动脉硬化性闭塞症的临床特点以及两者的鉴别诊断。方法对我科自1998年6月-2002年4月,被延误诊治的10例老年腰椎管狭窄症伴下肢动脉硬化性闭塞症患者的临床表现、诊断和治疗过程进行回顾性分析。结果10例患者均有间隙跛行,首先以腰椎管狭窄症收治,6例骨科手术治疗,4例保守治疗,疗效差。最后被确诊10例均有不同程度的下肢血管硬化性闭塞改变,5例介入治疗,3例药物治疗,2例血管外科手术治疗,对治疗均表示满意。结论老年腰椎管狭窄症伴下肢动脉硬化性闭塞症的临床表现相似,易混淆。老年下肢间隙性跛行的患者,诊断腰椎管狭窄症的同时必须排除下肢动脉硬化性闭塞症。对下肢血管硬化性闭塞症缺乏认识是其被延误诊治的主要原因。

Objective:To explore clinical characteristics and differential diagnosis of the lumbar spinal stenosis with arteriosclerosire occlusion of low extremity in old people.Methods:In this retrospective study,the authors reviewed the presentations,diagnosis and treatment in 10 patients who were suffered from the lumbar spinal stenosis with arteriosclerosis occlusion of low extremity between Jun,1998 and Apr,2002.Results:All the patients had the intermittent claudication.On the first day,they were hospitalized with spinal stenosis and 6 were performed with operation,4 were conservative treatment.Due to poor results of treatment,the arteriosclerosis occlusion of low extremities were considered.The different degree of arteriosclerosis occlusion were found in 10 patients,and they were treated with interventional therapies in 5,medications in 3,vascular surgeries in 2.Good results showed in 10 patients.Conclusion:The clinical presentations of the lumbar spinal stenosis are similar to the arteriosclerosive occlusion of low extremity in old people,they are easily confounded.The old patients with the intermittent claudication are usually considered to be lumbar spinal stenosis,but simultaneously we should pay more attention to the possibility of disease of arteriorsclerosive occlusion of low extremity.We think that the main reason of misdiagnoses is lack of knowledge of arteriosclerosive occlusion in old patients.