老年腰椎间盘突出症患者手术疗效的影响因素及对策  

Affecting factors and strategies of surgical treatment for elder people with lumbar disc herniation

作　　者：梁智林[1] 臧传义[1] 杨波[1] 唐杰[1] 赵小林[1] 佟训哲 高茂龙[2] Liang Zhilin;Zang Chuany;Yang Bo;TangJie;ZhaoXiaolin;TongXunzhe;Gao Maolong(Department of Orthopedics, Beijing Geriatric Hospital, Beijing 100095, China;Institute ofSenile Diseases and Rehabilitation, Beijing Geriatric Hospital, Beijing 100095, China)

机构地区：[1]北京老年医院骨一科,2100095 [2]北京老年医院老年病临床与康复研究所,2100095

出　　处：《中华老年骨科与康复电子杂志》2019年第3期130-134,共5页Chinese Journal of Geriatric Orthopaedics and Rehabilitation(Electronic Edition)

基　　金：首都卫生发展科研专项(首发2018-1-2191)

摘　　要：目的探讨老年患者腰椎间盘突出症手术疗效及并发症发生情况。方法回顾性收集我院自2010年1月至2017年1月手术治疗并完整随访的460例老年腰椎间盘突出症患者,其中男性274例(59.57%),女性186例(40.43%),平均年龄(77±17)岁,其中371例(80.65%)单间隙患者均采用椎板开窗减压髓核摘除术,89例(19.35%)双间隙椎间盘突出症患者均采用后路椎间融合钉棒系统内固定术,所有患者均采用日本骨科协会评分(JOA)进行疗效评定,随访并观察所有患者并发症的发生情况。结果 460例患者均随访时间12个月,全部获得随访,随访率100%。JOA评分中优313例(68.04%),良112例(23.34%),中32例(6.96%),差3例(0.65%),优良率92.39%,并发症发生率7.83%。所有患者术中、术后平均出血量为(200±35)ml,平均引流量为(150±20)ml。结论老年患者常合并全身疾病,手术难度大,影响手术疗效的因素众多,把好术前诊断、做好术前准备,术中仔细操作,术后密切观察患者病情变化,积极预防和及时处理术后并发症可有效提高手术疗效,减少并发症的发生。Objective To investigate the surgical outcomes and complications of lumbar disc herniation in elderly patients. Methods A retrospective collection of 460 elderly patients with lumbar disc herniation from January 2010 to January 2017 was performed, including 274 males (59.57%) and 186 females (40.43%), aged (77±17) years old, of which 371 (80.65%) patients with single gap were treated with laminectomy and nucleus pulposus removal, and 89 patients (19.35%) with double interstitial disc herniation were treated with posterior interbody fusion rod system. All patients were evaluated by the Japanese Orthopaedic Association JOA score, and complications were followed up. Results All 460 patients were followed up for 12 months, the followed up ratio for 100%. The JOA score was excellent in 313 cases (68.04%), good in 112 cases (23.34%), middle case in 32 cases (6.96%), poor in 3 cases (0.65%), excellent and good rate was 92.39%, and complication rate was 7.83%. The average bleeding volume of all patients during and after surgery was (200±35) ml, and the drainage volume was (150±20) ml. Conclusions Older patients often have systemic diseases. The operation is difficult, and many factors affecting the cure. The preoperative diagnosis, preoperative preparation, careful operation during operation, close observation of the patient’s condition after surgery, active prevention and timely manage post-complication can effectively improve the curative effect and reduce the occurrence of complications.

关 键 词：老年人 腰椎间盘突出症 外科手术 并发症 

分 类 号：R687.3[医药卫生—骨科学]