老年腰椎管狭窄症的手术疗效分析

The efficacy analysis of selective decompression of lumbar root canal of elderly lumbar spinal stenosis

目的探讨直视下选择性神经根管减压术和全椎板切除术治疗老年腰椎管狭窄症的临床疗效。方法回顾性分析2007年3月至2011年3月手术治疗的144例老年腰椎管狭窄症患者资料，男性64例，女性80例，年龄60—87岁，平均（66±5）岁。病程6～72个月，平均（12±16）个月。选择减压组70例采用直视下选择性神经根管减压术，椎板全切组74例采用全椎板切除术并行椎弓根钉内固定，采用日本骨科协会（JOA）评分及Oswestry功能障碍指数（ODI）评分评价临床疗效。各个时间点的数据采用配对设计资料的符号秩和检验进行统计学分析。结果144例患者手术顺利完成，无严重手术并发症。随访时间12～55个月，平均（31±6）个月。两组病例临床症状均消失或明显缓解，选择减压组及椎板全切组JOA评分分别从术前的14．0±1．6和13．6±1．7改善为末次随访时的20．3±1．7和20．2±2．0，差异有统计学意义（Z=2．41和2．23，P〈0．05）。选择减压组及椎板全切组ODI评分分别由术前的62％±4％和63％±4％改善为末次随访时的28％±4％和27％±3％，差异有统计学意义（Z=2．93和2．64，P〈0．05）。结论老年腰椎管狭窄症的手术治疗对于中央管狭窄的患者，采用全椎板切除术并行椎弓根钉内固定，疗效满意；对于神经根管狭窄明确而无中央管狭窄的患者，直视下选择性神经根管减压术是一种疗效可靠的术式。

Objective To evaluate the effect of the treatments of lumbar spinal stenosis by selective decompression of lumbar root canal and laminectomy. Methods From March 2007 to March 2011, 144 lumbar spinal stenosis patients were treated by selective decompression of lumbosaeral root canal and laminectomy. All of these patients included 64 male and 80 female patients, age range 60-87 years, average （66 ± 5 ） years. Duration 6-72 months, average （ 12 ± 16 ） months. The patients were divided into 2 groups according to surgical procedure underwent： group A including 70 patients who were treated with selective decompression of lumbar root canal, group B including 74 patients who were treated with traditional laminectomy. Five time points were selected to assess clinical effect using Oswestry disability index （ODI） and Japanese Orthopaedic Association （JOA）, which were pre-operation and 1 month, 6 months, 12 months and last follow-up. The data were analyzed through Wilcoxon matched-pairs signed-ranks test. Results All operations were completed well without severe complications. The duration of follow-up was 12-55 months, average （31 ±6） months. All patients＇ symptoms got improved or partial remission. The average pre- and post-operative scores of JOA in group A and B were from 14.0 ± 1.6 to 20. 3 ± 1.7, from 13.6 ± 1.7 to 20. 2 ± 2.0, respectively, there were significant statistical differences （ Z = 2.41 and 2. 23, P 〈 0.05）. The average pre- and post-operative scores of ODI in group A and B were from 62% ±4% to 28% ±4%, from 63% ± 4% to 27% ± 3%, respectively, there were significant statistical differences （Z = 2.93 and 2. 64, P 〈 0.05）. Conclusions Personalized treatment programs should be established for elderly lumbar spinal stenosis according to stenosis location. Laminectomy is carried out with the stenosis in the central spinal canal ; selective decompression of lumbosacral root canal is accepted with the stenosis in the nerve root canal without central stenosis.