老年性腰椎间盘突出症手术处理要点的探讨  

Investigation of operative process in treating lumbar intervertebral disc protrusion in aged patients

作　　者：张龙君[1] 郑晓东[1] 陈建良[1] 邵营钢[1] 陈静[1] 

机构地区：[1]上虞市中医院骨科,浙江上虞321300

出　　处：《中国骨伤》2013年第3期243-246,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨老年人(≥65岁)腰椎间盘突出症(LDH)手术方式及术中应注意的处理要点。方法:对2005年至2010年收治的43例老年性腰椎间盘突出症患者的临床资料进行回顾性分析,其中男25例,女18例;年龄65～70岁,平均67.6岁;病程6周～7年,平均10.2个月。所有病例采用开窗或扩大开窗髓核摘除的手术方法,根据突出部位、类型以及硬膜和神经根受压的情况,行单侧或双侧开窗,所有患者只作侧隐窝、神经根管潜行扩大,清除增生的骨赘及软组织,尽量保留双侧小关节突,保持节段稳定性。结果:所有患者获得随访,时间1.2～5.2年,无感染、神经损伤病例,功能恢复正常或接近正常。参照胡有谷评价标准:优25例,良15例,可2例,差1例。结论:合理的选择术式,完全解决病变部位的增生及扩大潜行的神经根管,彻底松解神经根是手术治疗老年性椎间盘突出症成功的关键。Objective ：To investigate the operative management and surgical techniques for lumber disc herniation （LDH） in aged patients （ ≥65 years）. Methods：From 2005 to 2010, the data of 43 patients with LDH underwent surgical treatment were retrospectively analyzed. There were 25 males and 18 females ,aged from 65 to 70 years old with an average of 67.6 years. The course of disease was from 6 weeks to 7 years with an average of 10.2 years. Fenestration discectomy or extended fenestra- tion discectomy and unilateral or bilateral fenestration were used according to the conditions of location,type of herniated macleos polposus and nerve root compression. Among the patients, the nerve root canal was enlarged, hyperplastic osteophyma and soft tissue were removed, bilateral articular process was reserved in order to maintain the stability of the lumbar segment. Results：All the patients were followed up from 1.2 to 5.2 years. According to the criteria of HU you-gu, 25 cases got excellent results, 15 good, 2 fair and 1 poor. No infection or nerve injury was found. Nerve function of patients had a normal or near normal recovery. Conclusion： For the treatment of LDH in aged patents,it is key that reasonably choose the operative method, completely remove the hyperplasy of diseased region and enlarge the nerve root canal, thoroughly loose the nerve root.

关 键 词：椎间盘移位 减压术 外科 老年人 回顾性研究 

分 类 号：R681.53[医药卫生—骨科学]