老年腰椎间盘突出症120例手术治疗体会

Surgical Treatment of 120 Elderly Patients with Lumbar Intervertebral Disc Protrusion

【目的】探讨老年腰椎间盘突出症的临床特点及治疗效果。【方法】对2003年9月至2009年5月手术治疗的120例65岁以上的老年腰椎间盘突出症临床资料进行回顾性分析。其中男58例，女62例，平均年龄69．8岁，包括半椎板切除，神经根管减压，突出髓核摘除17例，椎板间开窗减压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71例，全椎板切除32例，后者多伴有椎小关节增生内聚明显或合并腰椎失稳，行全椎板切除减压同时行椎弓根内固定加后外侧植骨或椎间植骨融合术，根据手术前后JOA评分评价手术疗效。【结果】随访时间6个月至3．5年，平均随访25个月，6个月时92例获得随访，JOA评分术后平均改善率为（85．1±13．4）％，优良率为80．4％（74／92），12个月时60例获得随访，JOA评分术后平均改善率为（80．3±11．1）％，优良率为71．7％（43／60）。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伴有腰椎管狭窄，采用腰椎后路单侧或双侧椎板间开窗，间盘切除、椎管神经根管扩大术效果较好。对合并椎小关节增生内聚严重，无法保留小关节突或合并腰椎不稳患者，采用腰椎后路减压、椎间盘摘除、椎弓根螺钉系统固定加后外侧或椎间植骨融合疗效满意。

[Objective] To explore the clinical characteristics and therapeutic effect of senile lumbar disc herniation（LDH）. [Methods]The clinical data of 120 senile patients aged over 65 years old with LDH were retrospectively analyzed. All patients included 59 males and 62 females. The mean age was 69.8 years. Hem- ilaminectomy, nerve canal decompression and removal of nucleus pulposus were performed in 17 cases. Interla- mellar fenestration, partial resection of medial intervertebral joint, lateral recessus expansion, nerve canal de- compression and removal of nucleus pulposus were performed in 71 cases. Laminectomy was performed in 32 cases which were mostly complicated with obvious vertebral facet hyperplasia and cohesion or lumbar destabili- zation, and underwent laminectomy, decompression, internal fixation with pedicle screw and lateral bone graft or lumbar interbody fusion. According to the JOA scores before and after operation, the surgical effect was e- valuated. [Results] The patients were followed up from 6 months to 3.5 years with the average of 25 months. At 6 months, 92 patients were followed up, and the average improvement of postoperative JOA score was （85. 1± 13.4）%, and the excellent rate was 80.4 % （74/92）. At 12 months, 60 patients were followed up, and the average improvement of postoperative JOA score was （80.3 ± 11.1） %, and the excellent rate was 71. 7 % （43/60）. There was significant difference in JOA score between before and after operation（ P d0.05）. [Conclusion] Posterior unilateral or bilateral interlaminar fenestration of lumbar, discectomy and expansion of spinal canal and nerve canal for the treatment of elderly patients with lumbar intervertebral disc protrusion and lumbar spinal stenosis has good effect. For patients who are complicated with severe facet hyperplasia and una- ble to reserve facet processus or complicated by instablility of lumbar vertebrae, lumbar posterior decompres- sion, discectomy, internal fixation with pedicle screw and post lateral or lumbar interbody fusion has satisfac- tory efficacy.