老年腰椎间盘突出症的治疗和临床特点分析

Clinical Characteristics and effect of Lumbar leg pain in Elderly by Two Ways

目的:探讨老年性腰椎间盘突出症的临床特点及手术与非手术综合疗法的临床疗效。方法:对72例60岁以上腰椎间盘突出症患者的临床资料进行回顾性分析。非手术综合疗法治疗采用我院根据骨筋肉并重原则制定的治疗腰椎间盘突出症的系统方法,包括中药制剂痛点注射和静脉注射、腰椎电动牵引、中药内服外敷、理伤手法治疗及指导患者进行腰背肌功能锻炼等;手术方法采用单侧或双侧椎板扩大开窗减压扩大神经根出孔术、半椎板切除术及全椎板切除术。结果:72例随访平均2.7年,按改良的日本骨科学会下腰痛评分法(M-JOA),两组治疗前后组间比较,治疗后较治疗前显著降低;疗后M-JOA评分两组间比较手术治疗组较综合疗法组降低,差异具有统计学意义(P<0.05);但60～69岁年龄组与70岁以上年龄组相比,疗效无明显差异(P>0.05)。结论:老年性腰椎间盘突出症的发病特征是高位间隙和多节段椎间盘突出比例增加为主;临床表现多样,建议对非手术治疗无效的老年患者应积极手术治疗。

Objective：To investigate the pathological and clinical characteristics and the effect of operation and no -operation in the lumbar disc herniation（LDH） of the elderly. Methods： the clinical data of the 72 patients aged over 60 years old with LDH were retrospectively analyzed. Results：All the 72 patients were followed up for an average of 2.7years. The excellent and good rate was 70.8% and the effective rate was 91.7% according to the M - JOA score. The curative effect in the group of patients with more than 70 years old group is lower that in the group of patients between 60 and 69 years old （P 〈0.05）. Conclusions：The characteristics of the disease in the elderly are the increase of the proportion of upper segments and muhi - spaces. The patients receiving the conservative treatment without effect should undergo the operation.