老年退行性腰椎滑脱症的外科治疗

Surgical treatment of senile degenerative lumbar spondyolisthesis

目的 探讨老年人退行性腰椎滑脱合并椎管狭窄症的外科治疗方法及远期疗效。方法 对近 5年来 2 3例老年退行性腰椎滑脱并发椎管狭窄者分别进行了椎板减压 ,部分病人附加了内固定或椎体间植骨融合术 ,评估了手术疗效和恢复活动后继续滑脱的可能性。结果 随访 8个月～ 4年 (平均 1年 3个月 )。术前腿痛麻 1 7例均获消失或明显缓解。术前双下肢无力不能站立行走者 6例 ,术后 2～ 3个月均能行走 ,生活自理 ,其中5例尿便功能障碍者也恢复括约肌功能。术后 X线平片证实 ,继续滑脱者仅 2例 ,滑脱度增加不足 5%。结论 老年人因合并骨质疏松症、心脑等疾病 ,手术不宜过大 ,不宜附加内固定和另外取骨植骨融合 ,因而增加手术时间和术后卧床时间。

? Objective To explore the surgical therapy and long term result of senile degenerative lumbar spondyolisthesis with lumbar spinal stenosis.Methods for 5 years,23 cases of senile degenerative lumbar spondylolisthesis with lumbar spinal stenosis received decompressive laminectomy,partial patients appended internal fixation or interbody fusion with autogenous bone graft,evaluated the therapeutic effect of surgery and the possibility of continue-slipping after activity recovery.Results Follow up period was from 8 months to 4 years with an average of l year and 3 months.17 cases with leg pain and numbness preoperatively disappeared or relieve remarkably after surgery;6 cases with lower extremities weakeness and motion deficit could walk after 2～3 months postoperatively,5 cases of them with bowl or bladder dysfunction recovered sphincter function after surgery.Postoperative x ray plain film confirmed,only 2 cases with continue slipping,the degree of slipping increased no more than ≤5%.Conclusions The elderly often accompany osteoporosis,heart and brain disesase,the excessive operation is inadvisable, it is inadvisable to append internal fixation and interbody fusion with autogenous bone graft, because they will prolong the operative time and postoperative bed time.Enlarged decompresive laminectomy limitedly and discedomy have a significant effect on relieving nerve compression and cauda equina injury. 〔