老年腰椎间盘突出症的手术治疗

The clinical effect observation of lumbar intervertebral disc herniation in the elderly

目的 探讨老年腰椎间盘突出症的特点与手术治疗效果，方法 对62例老人腰椎间盘突出症患者的临床与病理特点进行分析。均行腰椎后路椎板减压髓核摘除术，其中小切口开窗35例，半椎板切除20例，全椎板切除7例，根据手术前后JOA评分评价手术疗效．结果老年腰椎间盘突出症病理以髓核组织的脱水，纤维环的破裂，小关节囊、周围韧带及软骨终板退变为主要特点．临床特点为下肢疼痛多发，腰部活动受限较多；双下肢神经系统检查肌力下降明显，生理反射改变明显。62例平均随访1．9年，JOA评分术后平均改善率为68.9％，手术前后JOA评分比较差异有显著性意义（P〈0.05）。结论 老年腰椎间盘突出症患者病程长，体征多，病理改变明显．行腰椎后路椎板减压髓核摘除术。手术效果满意。

Objective To study the chavacterstics and surgical treatment for lumbar intervertebral disc herniations in the elderly. Method 62 cases of lumbar intervertebral disc herniations, including 35 males and 27 females with the mean age of 67 years ,underwent lambar posterior approach, of these 35 cases with minimal windowingincisions ; 20 cases with semi - laminectomy and 7 cases with omni - lamineetomy were documented . The surgical results were evaluated with Japanese Orthopedic Association score （JOA score）. Result The pathological characteristics of lumbar intervertebral disc herniation in the elderly showed dehydrolysis of nucleus pulposus and higher rate of annular fibrosus rupture . Cataplasis of ligamentum capsulare and terminal lamella were also found. The clinical characteristcs showed higher rates of pain in lower extremity and lumbar dysfunction, obviously change in muscle weakness and physio - reflect. 62 cases were followed up and the average periode was 1. 9 years . The increase rate of JOA score was 68.9% . Compared to pre - operation, there was a significant increase of JOA score postoperationly （P 〈0.05）. Conclusion Elderly cases with lumbar intervertebral disc herniations has long nature history, and more plysical signs, especially in pathological change. Surgery can ensure the satisfactory outcome .