老年腰椎间盘突出症的手术疗效观察

Surgical results of lumbar disc herniation in elderly patients

摘要:

目的 回顾性观察老年腰椎间盘突出症患者术后疗效。方法 报告1994年7月至2011年11月因腰椎间盘突出症在我院手术治疗的患者共95例, 年龄60～85（平均70.3）岁, 男59例, 女36例, 随访时间3个月～10年（平均35.7个月）。采用中华医学会骨科学分会脊柱外科学组腰背痛手术评定标准和日本骨科学会评分标准, 比较不同手术方式（单纯椎间盘切除和椎间盘切除并内固定融合）、不同减压方式（开窗、半椎板切除和全椎板切除）和不同随访时间（3年以内, 3～5年, 5年以上）的疗效。结果 95例患者总优良率为84.2%, 单纯椎间盘切除组和椎间盘切除并内固定融合组优良率分别为80.5%, 87.0%, 两组差异无统计学意义（P = 0.694）; 改善率分别为（60.89±32.62）%,（65.74±26.32）%, 两组改善率差异无统计学意义（P = 0.636）。开窗组、半椎板切除组和全椎板切除组优良率分别为80.6%, 91.3%和85.4%, 3组间差异无统计学（P = 0.958）, 3组改善率分别为（59.84±29.84）%,（62.30±27.10）%和（62.94±31.96）%, 3组间差异无统计学（P = 0.835）。随访时间3年以内组, 3～5年组, 5年以上组, 其优良率分别为90.6%, 77.8%和79.2%, 3组间优良率差异无统计学（P = 0.660）; 3组术后改善率分别为（62.01±25.97）%, （55.06±35.89）%, （60.83±33.73）%, 3组间差异无统计学意义（P = 0.811）。结论 单纯椎间盘切除与椎间盘切除并内固定融合治疗老年腰椎间盘突出症随访可获得良好疗效, 开窗组、半椎板切除和全椎板切除均可获得良好疗效, 且其疗效随着随访时间延长无明显变化。

Abstract:

Objective To investigate retrospectively the effects of surgical treatment for elderly patients with lumbar disc herniation. Methods A follow-up was conducted in patients who underwent surgery for lumbar disc herniation from July 1994 to November 2011 in our hospital. Ninty-five cases, (59 male and 36 female), aged from 60 to 85 with the average age of 70.3, were followed up for 3 months to 10 years with a mean follow-up of 35.7 months. The standards of Scoring System of Spinal Section of Chinese Orthopaedic Association (SSCOA) and Japan Orthopaedic Association (JOA) were used to investigate the differences in therapeutic effects between various surgery methods(discectomy or arthrodesis), decompression tactics(fenestration, hemilamine- ctomy or laminectomy) and follow up time(within 3 years, 3 to 5 years, or up 5 years). Results According to SSCOA, the total efficiency rate for lumbar disc herniation was 84.2%, whereas the rates in discectomy group and arthrodesis group were 80.5% and 87.0% respectively, without significant difference (P=0.694). Meanwhile according to JOA, the improvement rates in discectomy group and arthrodesis group were (60.89±32.62)% and (65.74±26.32)% respectively, without significant difference (P=0.636). The efficiency rates in fenestration group, hemilaminectomy group and laminectomy group were 80.6%, 91.3% and 85.4% respectively and without significant difference among groups (P=0.958), meanwhile the improvement rates were (59.84±29.84)%, (62.30±27.10)% and (62.94±31.96)% respectively, without significant difference (P=0.835). Of patients receiving follow-up within 3 years, 3 to 5 years , and up 5 years, the efficiency rates were 90.6%, 77.8% and 79.2% respectively, without significant difference (P=0.660), meanwhile, the improvement rates were (62.01±25.97)%, (55.06±35.89)% and (60.83±33.73)% respectively, without significant difference (P=0.811). Conclusion Discectomy group and arthrodesis group may achieve satisfactory results as treatment of lumbar disc herniation in elderly patients. Fenestration, hemilaminectomy and laminectomy may all have good effect. There is no significant difference in curative effects between various follow-up times.