选择性减压融合治疗老年退变性腰椎管狭窄症

Selected Decompression and Fusion for Elderly Degenerative Lumbar Spinal Stenosis

目的探讨选择性减压融合治疗老年退变性腰椎管狭窄症患者的临床疗效。方法 27例老年退变性腰椎管狭窄症患者,术前根据患者病史、体征和影像学表现确定减压节段及选择融合节段,对其进行选择性减压融合手术。术前、术后应用Japanese Orthopeadic Association(JOA)功能评分法及visual analogue scale(VAS)进行主观评估,Lenkl法评价植骨融合情况。结果 27例患者共减压46节段,平均减压1.7节段;共融合38节段,平均融合1.4节段。术后随访12～48个月,平均27个月。临床功能JOA评分由术前13.89±3.12分增加到24.15±3.56分(P<0.05),腰痛VAS评分由术前7.97±1.83分改善至术后3.11±0.89分(P<0.05),腿痛VAS评分由术前8.99±2.27分改善至术后1.49±0.38分(P<0.05)。植骨融合情况为Lenkl分级:A级18例,B级9例,同时融合部位邻近节段也未发现退变加速征象。结论根据术前的临床症状、体征以及影像检查结果对老年退变性腰椎管狭窄症患者制定"个性化"的手术方案在临床安全、有效。

Objective To explore therapeutic effect of selected decompression and fusion for elderly degenerative lumbar spinal stenosis.Methods 27 elderly cases of degenerative lumbar spinal stenosis were reviewed retrospectively.The involved segments were determined by history,signs and imaging findings.Then we carried out the decompression section and fusion segments by selected decompression fusion surgery.The clinical outcomes were evaluated by Japanese Orthopedic Association（JOA） score and visual analogue scale（VAS）,and the bone graft fusion was evaluated by Lenkl subjective assessment before and after operation as well.Results Decompression was done on 46 segments and fusion was done on 38 segments in 27 patients.The average number of decompression was 1.7 segments and fusion was 1.4 segments.The mean follow-up was 27 months（12~48 months）.Preoperative clinical function by JOA score 13.89 ±3.12 points increased to 24.15 ±3.56 points（P0.05）,preoperative low back pain by VAS score 7.97 ±1.83 points decreased to postoperative 3.11±0.89 points（P0.05）,preoperative leg pain by VAS score 8.99±2.27 points decreased to postoperative 1.49±0.38 points（P0.05）.Lenkl situations for bone graft fusion of grading：A grade,18 cases;B grade,9 cases,meanwhile fusion site adjacent segments degeneration aggravating also did not find signs.Conclusion According to the preoperative clinical symptoms,signs and imaging findings in elderly patients with degenerative lumbar spinal stenosis patients to develop ＂personalized＂ program of clinical surgery is safe and effective.