老年腰椎管狭窄症106例手术疗效分析

Analysis of effect of surgical tyeatment of lumbar spinal styenosis in senile people

目的探讨老年腰椎管狭窄症患者减压治疗的疗效。方法1997年1月～2003年12月收治70岁以上腰椎管狭窄症患者175例，对其中随访2～6年（平均3年10个月）的106例患者的手术疗效进行回顾性分析。男49例，女57例；年龄70～82岁，平均76．3岁；病史4～10年，平均6．7年。所有患者均经过正规保守治疗。42例患有1种与腰椎管狭窄症并存的内科疾病，55例有2种或以上的内科疾病。本组所有患者术前平均连续活动时间小于15min。95例进行椎板减压术，11例采用椎板减压、椎弓根固定、椎间植骨融合术。结果本组无死亡病例。38例术后出现并发症，经有效治疗后痊愈出院。随访期间37例腰部症状得到改善，63例双下肢麻木的症状得到改善，6例症状缓解不明显。Oswemry评分66例〈20％，34例〈10％。94％的患者自诉生活质量明显提高，术后平均连续活动时间大于30min。结论在积极控制共存疾病的基础上，手术减压治疗对老年腰椎管狭窄症神经功能的恢复具有重要作用，并可获得较满意的临床疗效。

Objective To investigate the effect of surgical decompression on lumbar spinal stenosis in senile people. Method 175 senile patients with lumbar spinal stenosis were admitted from Jan. 1997 to Dec. 2003. Among them, the data of effect of surgical decompression in 106 cases, including 49 males and 57 females, age ranged from 70 to 82 years, all of them having a disease history of 4-10 years, and followed-up for 2-6 years after the operation. Their data were analyzed retrospectively. All the patients had been treated conservatively. 42 patients were complicated by one internal disease, and 55 complicated by at least 2 internal diseases. In all the patients continuous movement could not last longer than 15 min before operation. Lamina decompression was done in 95 patients, and a combined operation of lamina decompression, pedicle fixation and post-lateral bone grafting in 11 patients. Result All the patients survived the operation. Complications occurred in 38 cases, and the patients recovered after effective treatment. During follow-up, lumber complaint was improved in 37 cases, numbness in both legs was improved in 63 cases, and no satisfactory improvement was seen in 6 cases. In 66 cases the Oswestry score was lower than 20%, and in 34 cases it was lower than 10%. The result of surgical decompression was satisfactory in 94% of cases, and the average continuous movement was prolonged to over 30 min after operation. Conclusion Based on the effective control of complicated disease, the operative treatment of lamina decompression with fusion or no fusion played an important role in the recovery of neurological function in senile patients with lumbar stenosis.