同期手术治疗颈腰椎椎管狭窄症

A Single-stage Surgery of Coexisting Lumbar and Cervical Stenosis

目的评价同期手术治疗颈椎、腰椎管狭窄症的疗效及安全性。方法 2005年3月至2012年5月,纳入颈椎、腰椎管狭窄症患者61例,同一患者均采用两批脊柱外科医师分别行同时联合手术。依据日本骨科协会(Japanese orthopaedic association,JOA)评分系统、Oswestry功能障碍指数(oswestry disability index,ODI)、Nurick评分、患者满意指数、JOA改善率及并发症等进行疗效测评。结果随访12个月,平均JOA提高4.2分,平均ODI改善39.4,平均Nurick分级改善1.16级,平均患者满意度为(2.53±0.87)分,平均JOA康复率为(47.36±25.85)%。在小于60岁的患者中,ODI(P=0.03)及Nurick分级(P=0.04)显著改善。结论同期手术治疗并存的颈椎、腰椎椎管狭窄症是可行的,年龄、术中失血及手术时间可能与手术效果及并发症相关。不建议年龄大于等于60岁患者采用同时联合手术。

Objective To evaluate the treatment of a single-stage suregery of coexisting lumbar and cervical stenosis and relative factors. Methods From March 2005 to May 2012,61 cases with coexisting lumbar and cervical stenosis received a single-stage surgery by two teams. Results were evaluated with modified Japanese Orthopedic Association score（ JOA）,oswestry disability index（ ODI）,Nurick grade（ NG）,patient satisfaction index,JOA recovery rate,blood loss and complication. Results The JOA,ODI and NG showed an average improvement of 4. 2,39. 4,1. 16 points at 12 months,respectively. Patient satisfaction index was（ 2. 53 ± 0. 87）. The average JOA recovery rate was（ 47. 36 ± 25. 85） %. In the age group below 60,the improvement was statistically higher in terms of ODI（ P = 0. 03） and NG（ P = 0. 04）. Conclusion A single-stage suregery maybe effective and saft in the treatment of coexisting lumbar and cervical stenosis. Age,blood loss and duration of surgery decide the complication rate and outcome of surgery. However,this type of surgery is not recommended in patients above the age of 60 years.