老年腰椎间盘突出症特点与开放减压椎间盘切除
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解放军第971医院

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Characteristics and open decompression combined with discectomy for lumbar disc herniation in the elderly
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The 971th Hospital of PLA

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    摘要:

    [目的]探讨老年人腰椎间盘突出(lumbar disc herniation, LDH)的临床特点,以及开放减压椎间盘切除的临床结果。[方法] 1995年12月至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,尽量保留骨性结构。[结果]所有患者均顺利手术,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日内恢复。随访6个月至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例完全无痛,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:

    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 diseasewas 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 structure preserved as much as possible ifdecompressionsufficient.[Results] All patients were successfully operated on without death and neurovascular injuries. Of them, 56 cases (93.33%) were complicated with lumbar spinal stenosis.After operation, 8 patients (13.33%) presented 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 significantlyover 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 level.[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.

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  • 收稿日期:2022-03-04
  • 最后修改日期:2022-03-06
  • 录用日期:2022-03-10
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