高龄患者腰椎间盘突出症36例临床特点及疗效分析

Clinical characteristics and therapeutic outcomes in aged patients with lumbar disc herniation

目的 探讨高龄腰椎间盘突出症的临床特点、诊断及手术治疗方法。方法 对 1996年 8月～ 2 0 0 1年 8月间我院手术治疗的 36例 6 5岁以上的腰椎间盘突出症病例进行回顾性分析。结果 本组 36例占我院同期椎间盘手术 818例的4 .4 %。临床主要表现为有慢性腰腿痛病史伴间歇性跛行 ,有相应神经根支配的肌肉感觉范围的改变 ,腰痛范围大 ,直腿抬高试验多呈阳性 ,多数合并有心肺疾病和糖尿病病史 ,应用保守治疗无效。X片及CT片在明确诊断方面有重要帮助。 36例均行半椎板切除或椎板间开窗潜行扩大减压术 ,术后优良率达 86 .2 %。结论 高龄患者由于脊椎退行性改变的缘故。手术以选择对脊柱稳定性破坏较小的半椎板切除及椎板间开窗术式为宜 。

Objective To evaluate the clinical characteristics,diagnosis and surgical therapy of aged patients with lumbar disc herniation(LDH).Methods 36 patients with LDH over 65 years old treated by surgical therapy were analysed retrospectively from August 1996 to August 2001.Results The 36 cases accounted for 4.4% of 818 such patients treated operatively in the same time period.The main clinical symptoms included chronic pain in the back and leg,intermitent claudictation,changes in sensory extent of bone and muscles regulated by related nerve roots,severe lumbago,and positive straight-leg raising test(+).The majority of patients had concurrently heart and lung diseases,and diabetes mellitus.Non-operative treatment was ineffective.X-ray and CT were of great importance in differential diagnosis.The 36 patients were treated by semilaminectomy or interlaminar widened windowing and decompression.The postoperative good response rate was 86.2%.Conclusions Because of the degereration of spine,LDH is always accompanied by thickening yellow ligament in aged patients with severe symptoms.Semilaminectomy and interlaminar windowing,which affects the stability of spine to minor extent,should be choosed,and the protruded discs should be removed at the same time.