老年退行性腰椎管狭窄症的外科治疗

Surgical treatment of the old with degenerative lumbar spinal stenosis

目的:探讨老年退行性腰椎管狭窄症患者围手术期特点及外科治疗方法。方法:回顾性分析2000年1月至2007年10月行手术治疗的60岁以上退行性腰椎管狭窄症患者36例,男16例,女20例;年龄60～81岁,平均67.5岁。36例中行潜行扩大开窗神经根管减压术6例、单节段全椎板切除减压术10例、全椎板切除减压融合内固定术20例。结果:围手术期无死亡病例,出现并发症14例:3例脑脊液漏,1例切口延迟愈合,2例心律失常,1例呼吸系统感染,4例腹胀、腹痛等胃肠道症状,2例泌尿系感染,1例焦虑等精神症状。经对症及内科联合处理好转。36例均获得随访,时间0.5～5年,平均2.5年。Oswestry评分从术前(45.66±7.12)分改善至(16.80±5.75)分,差异具有统计学意义(P<0.05)。结论:年龄和身体条件不是老年退行性腰椎管狭窄症手术的绝对禁忌证,选择适当的手术方式,在积极控制并存疾病的基础上,仍能获得满意的疗效。

Objective：To investigate the perioperative characteristics and surgical methods in treating the old with degenerative lumbar spinal stenosis. Methods：From January 2000 to October 2007,36 patients with degenerative lumbar spinal stenosis with the age more than 60 years,including 16 males and 20 females,the age from 60 to 81 years with an average of 67.5 years. Of all patients,6 cases were treated by simple surgical decompression,16 cases by decompressive laminectomy,20 cases by decompressive laminectomy combined with internal fixation and fusion. Results：No death cases occurred during perioperation and complication occurred in 14 cases,including cerebrospinal fluid leakage in 3 cases,incision late healed in 1 case,heart abnormal symptom in 1 case,respiratory infection in 1 case,gastrointestinal symptom in 4 cases,urinary system infection in 1 case,spirital symptom in 1 case. After symptomatic treatment,all complications improved. All the cases were followed up from 6 months to 5 years with an average of 2.5 years. Oswestry scoring improved from preoperative 45.66±7.12 to postoperative 16.80±5.75,there was significant difference between before and after operation （P0.05）. Conclusion：The age and heath condition are not operative absolute contraindication in treating old with degenerative lumbar spinal stenosis,with the proper operation modus after controlling concomitant diseases,the surgical treatment could guarantee the satisfactory therapeutic effect.