老年腰椎间盘突出症特点与开放减压椎间盘切除

Characteristics and open decompression combined with discectomy for lumbar disc herniation in the elderly

摘要:

[目的]探讨老年人腰椎间盘突出症(lumbar disc herniation, LDH)的临床特点，以及开放减压椎间盘切除的临床效果。[方法] 1995 年 12 月—2005 年 12 月，共 60 例 60 岁以上 LDH 患者纳入本研究，单项合并病为 50.00% (30/60)，多种合并病为 41.66%(25/60)。均行开放减压椎间盘切除，在保证充分减压的前提下，尽量保留骨性结构。[结果]所有患者均顺利完成手术，术中无死亡，无血管和神经损伤；手术见合并腰椎管狭窄 56 例，占 93.33%。术后 8 例(13.33%)患者出现谵妄等神志异常，经相应处理，均于 4 d 内恢复。随访 6 个月~8 年，4 例患者死于与手术无关的疾病。随时间推移，VAS 和 ODI 评分显著下降 (P＜0.05)，而 JOA 评分显著增加 (P＜0.05)。末次随访时，47 完全无痛，恢复病前生活能力，9 例患者活动时有不适，生活质量未恢复至病前水平。[结论]老年 LDH 临床表现不典型，多合并内科病，局部多伴椎管狭窄或脊柱畸形。开放减压椎间盘切除术可取得满意临床效果。

Abstract:

[Objective] To investigate the clinical characteristics of lumbar disc herniation (LDH) in the elderly, and the outcome of open decompression combined with discectomy. [Methods] From December 1995 to December 2005, a total of 60 patients who were over 60 years of age and suffered from LDH were enrolled in this study. A single underling disease was noted in 50.00% (30/60) , while multiple comorbidities were found in 41.66% (25/60) . Open decompression combined with discectomy was performed in all patients with bony struc- ture preserved as much as possible if decompression sufficient. [Results] All patients were successfully operated on without death and neu- rovascular injuries. Of them, 56 cases (93.33%) were complicated with lumbar spinal stenosis. After operation, 8 patients (13.33%) present- ed delirium and other mental abnormalities, which were recovered within 4 days after corresponding treatment. During follow-up lasted for 6 months to 8 years, 4 patients died of a disease unrelated to the surgery. The VAS and ODI scores decreased significantly (P＜0.05) , while JOA score increased significantly over time (P＜0.05) . At the latest follow- up, 47 patients were completely painless and recovered their pre-disease ability of life, whereas 9 patients had discomfort in some extent during activities with quality of life under the pre-disease lev- el. [Conclusion] The clinical manifestations of LDH in the elderly are not typical, most of them are complicated with underling diseases, and local spinal canal stenosis or spinal deformity. Open decompression combined with discectomy does achieve satisfactory clinical results for the scenarios.