Liu Qinyi, Yang Yougeng, Wang Xiangzhi
Department of Orthopedics, Second Hospital of Jilin University, Changchun Jilin, 130041, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006 Apr;20(4):416-8.
To investigate the surgical method and perioperative treatment for senile lumbar disease accompanied by internal disease.
From June 2000 to December 2003, the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients' conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbar disc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis. The JOA score was 11.6 +/- 2.5. There were 3 patients undergoing fenestration + discectomy, 16 undergoing semi-laminectomy + discectomy, 82 undergoing total-laminectomy + discectomy, 5 undergoing total-laminectomy+discectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis.
With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after operation. According to the JOA standards, the average alleviation rate was 87.9%.
Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.
探讨老年腰椎疾病合并内科疾病的手术方法及围手术期治疗。
2000年6月至2003年12月，对患者术前进行全面的神经及体格检查，因为内科疾病的治疗可改善患者状况。对125例患者行腰椎手术，其中单纯腰椎间盘突出症23例，腰椎管狭窄症13例，腰椎间盘突出症合并腰椎管狭窄症81例，腰椎滑脱症8例。日本骨科学会（JOA）评分为11.6±2.5。3例行开窗+椎间盘切除术，16例行半椎板切除+椎间盘切除术，82例行全椎板切除+椎间盘切除术，5例行全椎板切除+椎间盘切除+椎弓根内固定术，11例行椎板减压+神经根通道减压术，8例腰椎滑脱症行椎弓根螺钉固定+植骨融合术。
经有效的内科治疗，内科疾病对手术影响较小。术后观察到功能改善及骨融合。按照JOA标准，平均缓解率为87.9%。
早期神经检查及内科疾病的恰当治疗是老年腰椎疾病患者手术成功的关键。影像学资料对避免误诊很重要。
