老年腰椎间盘突出症诊疗指南

Clinical practice guidelines for diagnosis and treatment of lumbar disc herniation in the elderly

腰椎间盘突出症是一种骨科常见病,随着老龄化社会的到来,老年腰椎间盘突出症患者呈逐渐增多的趋势。鉴于老年腰椎间盘突出症作为一种特殊类型的腰椎间盘突出症类型,有必要对老年腰椎间盘突出症的诊疗方法进行总结和规范其诊疗流程。本指南遵循循证医学的原则,参照2013年北美脊柱外科学会制订的《腰椎间盘突出症伴神经根病诊疗指南》和2020年中华医学会骨科学分会脊柱外科学组和骨科康复学组共同制定的《腰椎间盘突出症诊疗指南》,组建指南制订专家工作组及确定临床问题,根据证据推荐分级的评估、制订与评价工作组相关方法进行检索文献的证据等级和推荐等级评定,形成推荐意见;经专家工作组三轮讨论,最终确定终稿。指南从老年腰椎间盘突出症的定义、病理特点、诊断、保守治疗、手术治疗、手术并发症、加速康复理念的应用7个方面对老年腰椎间盘突出症的诊疗措施进行阐述,为老年腰椎间盘突出症的诊断和治疗提供可靠的临床理论依据。

Lumbar disc herniation is a common orthopaedic disease.With the coming of aging society,the incidence of lumbar disc herniation in the elderly increases gradually.As a special type of lumbar disc herniation,it is necessary to standardize the diagnosis and treatment procedures of lumbar disc herniation in the elderly.Based on the principle of evidence⁃based medicine,the guidelines were developed according to clinical guidelines of diagnosis and treatment of lumbar disc herniation with radiculopathy developed by North America Spine Society in 2013 and clinical practice guidelines for diagnosis and treatment of lumbar disc herniation by Chinese Orthopaedic Association of Spinal Surgery Group and Chinese Orthopaedic Association of Orthopaedic Rehabilitation Group in 2020.After expert working group development and clinical problem determination,Grading of Recommendations Assessment Development and Evaluation System was used to rate the quality of evidence and determined the strength of recommendations.After three rounds of discussions in expert work group,clinical guidelines for diagnosis and treatment of lumbar disc herniation in the elderly were finally developed.The guidelines defined the screening for definition,pathological characteristics,diagnosis,conservative treatment,surgical treatment,surgical complications,application of enhanced recovery after surgery in lumbar disc herniation in the elderly.The guidelines will provide a reliable clinical basis for the diagnosis and treatment in lumbar disc herniation in the elderly.