Strömqvist Fredrik, Strömqvist Björn, Jönsson Bo, Karlsson Magnus K
Departments of Clinical Sciences and Orthopaedics, Clinical and Molecular Osteoporosis Research Unit, Skane University Hospital, Lund University, Malmö, Sweden.
Department of Orthopaedics, Skane University Hospital, 205 02, Malmo, Sweden.
Eur Spine J. 2016 Nov;25(11):3528-3535. doi: 10.1007/s00586-016-4638-6. Epub 2016 Jun 10.
Outcome after lumbar disc herniation (LDH) surgery in middle-aged patient is usually reported to fulfill the criteria for successful outcome. It is also known that women in these years have an inferior outcome compared to men. This study evaluates whether the same gender differences exist in elderly.
In the national Swedish register for spine surgery (SweSpine) we identified 1668 patients ≥65 years. 1250 of these patients had both pre- and 1-year postoperative data registered, 53 % males with mean age 70.6 ± 5.0 (mean ± SD) and 47 % females with mean age 71.3 ± 5.2. All were surgically treated due to LDH between 2000 and 2012.
Before surgery both men and women had severe impairment, compared to normative data, in all patient-reported outcome measures (PROMs), with women having inferior status to men. Improvement by surgery was similar in both genders but neither of them reached normative values in quality of life as compared to normative age-matched individuals. As a consequence of this women 1 year after surgery had more back and leg pain, higher consumption of analgesics, greater impairment in walking distance and inferior scoring in virtually all registered PROMs compared to men (all p < 0.005). In spite of this women were as satisfied with the surgical outcome as the men.
Elderly women with LDH surgery report inferior outcome compared to males, mainly as a result of being referred to surgery with an inferior status but are despite this as satisfied with outcome as the men.
通常认为中年患者腰椎间盘突出症（LDH）手术后的结果符合成功标准。众所周知，这些年里女性的手术结果比男性差。本研究评估在老年患者中是否存在同样的性别差异。
在瑞典全国脊柱手术登记系统（SweSpine）中，我们确定了1668例年龄≥65岁的患者。其中1250例患者术前和术后1年的数据均有记录，男性占53%，平均年龄70.6±5.0（均值±标准差），女性占47%，平均年龄71.3±5.2。所有患者均在2000年至2012年期间因腰椎间盘突出症接受手术治疗。
与标准数据相比，术前男性和女性在所有患者报告结局指标（PROMs）上均有严重损伤，女性状况比男性差。手术改善在两性中相似，但与年龄匹配的标准个体相比，他们在生活质量方面均未达到标准值。因此，与男性相比，术后1年女性有更多的腰腿痛、更高的镇痛药消耗量、行走距离损伤更大，并且几乎所有登记的PROMs评分都更低（所有p<0.005）。尽管如此，女性对手术结果的满意度与男性相同。
接受LDH手术的老年女性报告的结果比男性差，主要是因为她们在手术时状况较差，但尽管如此，她们对结果的满意度与男性相同。
