高龄患者腰椎退变性疾病的手术治疗

Surgical treatment of degenerative lumbar spine diseases in elderly patients

目的探讨高龄腰椎退变性疾病的手术治疗的安全性和临床疗效。方法2008年1月至2011年12月，选择性手术治疗42例腰椎退变性疾病患者（腰椎间盘突出症6例，腰椎间盘突出症合并椎管狭窄10例，腰椎退变性滑脱症6例，腰椎管狭窄症20例）。男28例，女14例；年龄75—84岁，平均77．2岁。42例随访1年5个月至5年4个月，平均2年7个月。对患者的术前伴发疾病、术后并发症及其处理进行总结。临床疗效采用Oswest~功能障碍指数（oswestrydisabilityindex，ODI）和视觉模拟评分法（visualanaloguescale，VAS）评定。随访拍摄腰椎正、侧位和动力位x线片，观察术后腰椎稳定性、腰椎融合和内置物的情况。结果术后并发症包括7例高血压者并发血压增高、1例冠心病者并发心绞痛、1例脑梗塞、4例肺部感染和3例脑脊液漏。术后1年或末次随访x线平片评估示：无手术节段失稳和内固定失败。ODI评分由术前（71．1±19．2）％改善至术后（22．0±11.3）％（P〈0．01）。腰痛VAS评分由术前（6．0±2．1）分改善至术后（2．2±1．7）分（P〈0．01o下肢痛VAS评分由术前（7．9±1．7）分改善至（3．1±2．1）分（P〈0．01o42例中39例对术后疗效满意，3例对术后疗效基本满意。结论高龄腰椎退变性疾病的患者积极控制伴发疾病和术”后并发症，能够安全度过围手术期，取得优良的临床效果。

Objective To investigate the safety and clinical effects of surgical treatment of degenerative lumbar spine diseases in elderly patients. Methods 42 patients with degenerative lumbar spine diseases who were enrolled from January 2008 to December 2011 selectively underwent surgical treatment, including 6 patients with lumbar disc herniation, 10 patients with lumbar disc herniation and spinal stenosis, 6 patients with degenerative lumbar spondylolisthesis and 20 patients with spinal stenosis. There were 28 males and 14 females, with an average age of 77.2 years old （ range; 75-84 years ）. They were followed up for a mean period of 31 months （ range; 17-64 months ）. The preoperative concomitant diseases, postoperative complications and relevant treatment methods were analyzed. The clinical effects were evaluated by the Oswestry Disability Index （ ODI ） and the Visual Analogue Scale （ VAS ）. Based on the anteroposterior （ AP ）, lateral and dynamic X-ray films of the lumbar spine during the follow-up, the lumbar spinal stability, lumbar spinal fusion and implants were observed after the surgery. Results The postoperative complications included 7 cases of increased blood pressure, 1 case of angina, 1 case of cerebral infarction, 4 cases of pulmonary infection and 3 cases of cerebrospinal fluid leakage. Operational segment instability or internal fixation failure was not found based on the X-ray films 1 year after the surgery or in the latest follow-up. The ODI was improved from （ 71.1±19.2 ） % preoperatively to （ 22.0±11.3 ） % postoperatively （ P〈0.01 ）. The VAS of low back pain was improved from （ 6.0±2.1 ） preoperatively to （ 2.2±1.7 ） postoperatively （ P〈0.01 ）. The VAS of lower leg pain was improved from （ 7.9±1.7 ） to （ 3.1±2.1 ） （ P〈0.01 ）. 39 of 42 patients got satisfied results, and the other 3 patients were basically content with the results. Conclusions With the concomitant diseases and postoperative complications actively controlled, elderly patients with degenerative lumbar spinal diseases can pull through the perioperative period successfully and obtain good clinical results.