提拉复位治疗老年腰椎退变性滑脱

Drawing back reduction for aged patients with degenerative spondylolisthesis

[目的]对70岁以上的老年患者行腰椎退变性滑脱手术复位的回顾性研究,并与70岁以下的患者进行比较,以此评估老年腰椎退变性滑脱患者提拉复位加椎间融合术的疗效。[方法]对103例腰椎退变性滑脱手术治疗的患者,根据年龄分为2组,A组年龄≥70岁,B组年龄﹤70岁。其中A组33例(32.0%),平均年龄74.3岁,B组70例(68.0%),平均年龄57.6岁。临床结果采用VAS和JOA进行评估。手术节段滑移百分比和局部腰椎前凸角的测量值术前术后进行比较。[结果]本组患者随访时间平均为34.6个月(24～48个月)。各种术前合并症在A组的28例(84.8%)患者中存在,明显多于B组。在相同的随访时间点上两组的VAS、JOA和JOA的恢复率评分没有显著差异。A组滑脱程度显著下降,由术前18.8%降至术后2.1%(P<0.001)同时局部腰椎前凸角由术前12.1°增加到16.4°(P<0.01)。在最后的随访中未发现影像上不愈合的迹象。术后并发症:A组11例(33.3%),明显高于B组。但在最后的随访中发现并发症并未影响术后临床结果。[结论]对老年腰椎退变性滑脱椎弓根螺钉提拉复位加椎间融合技术是安全有效的。

[ Objective ] A retrospective study was made for aged patients over 70 years old （ group A） with surgical reduc- tion for degenerative spondylolisthesis. The outcomes were compared with those of patients 69 years old or younger （ group B） as a control. To evaluate the surgical results of pedicle screws drawing back reduction and PLIF in aged patients. [ Methods ] Be- tween February 2005 and June 2007, a total of 103 consecutive patients with degenerative spondylolisthesis were surgically trea- ted. Group A included 33 patients （32.0%） with the mean age of 74. 3 years and group B consisted of 70 patients （68.0%） with the mean age of 57. 6 years. Clinical status was evaluated using VAS and JOA. Pre - and postoperative measurements of the percentage slip and local lumbar lordosis of the involved segments were reviewed. [ Results ] All the patients were followed up for a mean time of 34. 6 months （24 - 48 months） . A variety of pre - operative associated medical problems were found in 28 patients （84. 8% ） in group A, significantly more than that in group B. At the same follow -up time point, there was no sig- nificant difference between two groups in VAS, JOA and recovery rate of JOA. In group A, the preoperative slippage decreased significantly from 18.8% to 2. 1% postoperatively （P 〈 0. 001 ） and the preoperative focal dordosis increased from 12. 1 degrees to 16.4 degrees （P 〈0. 01 ） . There was no radiographic sign of non -union in final follow- up. Postoperative complications occurred in 11 patients in group A （33.3%）, with significantly higher incidence compared with group B. But the complications did not appear to affect the postoperative clinical results at final follow - up. [ Conclusion] For the aged patients with degenerative spondylolisthesis, drawing back technique with pedicle screws is an effective and safe surgical procedure.