老年腰椎间盘突出症的临床特点及手术治疗

The clinical characteristics and surgical treatments of the aged patients with lumbar disc herniation

目的探讨老年人腰椎间盘突出症的临床特点及手术方式。方法回顾性分析手术治疗60岁以上的腰椎间盘突出症68例的临床资料,包括开窗髓核摘除10例,半椎板切除减压突出髓核摘除12例,半椎板切除加椎间关节内侧部分切除、侧隐窝扩大、神经根管探查减压突出髓核摘除38例,全椎板切除减压突出椎间髓核摘除8例(其中4例伴有腰椎失稳,同时行椎弓根内固定加后外侧植骨融合术)。结果随访6个月～10年,疗效评定按Macnab标准,优48例,良8例,可6例,差6例,优良率为82.4%。结论老年人腰椎间盘突出症手术治疗方式,应根据其临床特点选择半椎板切除,突出髓核摘除。

Objective To investigate the clinical characteristics and surgical treatments of the aged patients with lumbar disc herniation （LDH）. Methods The clinical data of the operated 68 patients aged over 60 years old with LDH were retrospectively analyzed. Operation ways were as follows ： the nucleus pulposus were extirpated by fenestration in 10 cases, half vertebral lamina resection in 12 cases, resecting half vertebral lamina and inside part of intervertebral joints, expanding lateral recess, decompressing and exploring nerve root canal in 38 eases. Laminectomy and decompression, extirpated nucleus pulposus in 8 cases, 4 of them had lumbar unstability, so did posterior pedicel screw instrumentation and combine bone graft. Results After follow - up for 6 months to 10 years, the effects were evaluated by Macnab standard. The results showed, excellent effect were obtained in 48 patients, good in 8 patients, fair in 6 patients, and poor in 6 patients. The excellent and good rate was 82. 4%. Conclusion The choice of operation modes such as nucleus pulposus extirpation and half vertebral lamina resection in the elderly with LDH should depend on their clinical characteristics.