外科治疗对老年退行性腰椎管狭窄症的影响

Surgical therapy for degenerative lumbar spinal stenosis in elderly people

目的:探讨老年退行性腰椎管狭窄症患者外科减压治疗的效果。方法:退行性腰椎管狭窄症患者63例中,40例行单纯椎板切除减压术,10例行椎管扩大椎板成形术,13例采用椎板减压、椎弓根固定、椎间植骨融合术,对手术疗效和并发症进行回顾性分析,采用日本骨科学会(JOA)29分法进行评分并进行统计学分析。结果:无围手术期死亡病例。出现并发症12例次,经对症处理后好转。平均随访32个月,JOA评分从术前的(13.81±1.10)分改善至(5.24±1.12)分,改善率96%。术前平均评分与随访时平均评分比较差异有显著性(P<0.001)。所有患者连续行走距离从术前不足100m改善到至少500m。结论:术前控制伴发疾病,积极预防和处理术后并发症,手术治疗老年退行性腰椎管狭窄症是一种很好的选择。

Objective To evaluate the efficacy of surgical decompression for degenerative lumbar spinal stenosis. Methods We retrospectively analyzed the data on 63 patients who had undergone surgical decompression for degenerative lumbar spinal stenosis. 40 of 63 patients received simple laminectomy, 10 received spinal canal enlargement using restorative laminoplasty, and 13 received posterior decompression combined with pedicle fixation and interbody fusion using bone graft. The clinical outcomes of three different procedures were assessed using the JOA score. Results No perioperative deaths occurred. Complications developed in 13 patients, but the relevant symptoms were relieved after treatment. During a mean follow-up of 32 months, the JOA score was declined to 5.24 ± 1.12 from the baseline of 13.81± 1.10, with an improvement rate of 96%. The mean score during follow-up differed significantly from the mean baseline score（P〈 0.001 ）. The continuous ambulatory distance was postoperatively extended to at least 500 m from less than 100 m in all patients. Conclusions Under the conditions of preoperatively controlling coexisting systematic diseases and aggressively preventing and treating postoperative complications, surgical decompression is a very good approach for degenerative lumbar spinal stenosis.