高龄患者椎弓根钉内固定术的临床特点及疗效分析

Analysis of posterior lumbar interbody fusion(PLIF) in treating lumbar degenerative disease in elderly patients

目的 ：探讨高龄患者腰椎退行疾病经后路减压椎弓根钉棒内固定椎间融合治疗的临床疗效。方法 ：2010年3月至2013年5月收治28例80岁及以上高龄腰椎退行性疾病患者,其中男10例,女18例,年龄80-93岁,平均（85.44±3.66）岁,病程3-20年。采用经后路减压椎弓根钉棒内固定椎间融合治疗,记录手术时间、术中失血量及术后近远期并发症,术前和术后末次随访时分别进行JOA腰椎评分并计算临床改善率,并于术后末次随访时采用改良的Macnab标准评定疗效。结果：所有患者获得随访,随访时间12-40个月,平均26.5个月。手术时间（150.00±26.42）min,术中出血量（373.33±99.88）ml。JOA评分术前（12.30±2.43）分,末次随访时（24.81±2.09）分,较术前明显提高（P〈0.01）。手术前后的改善率为21%-89%,平均74.26%。末次随访时按照改良的Macnab标准评定结果,优16例,良10例,可2例。术后2周内,3例出现神经根牵拉刺激症状,3例出现伤口浅表感染愈合延迟,1例术中硬膜囊撕裂,出现脑脊液漏。1例患者术后34个月时出现相邻节段椎管退变狭窄。所有患者顺利融合,无内固定松动移位、假关节形成等其他并发症。结论：选择合适的病例,充分的术前准备,完备的术中操作及积极的术后管理和随访,即便是80岁及以上的高龄腰椎退行性疾病患者,采用经后路减压椎弓根钉棒内固定椎间融合治疗也可以取得满意的疗效。

Objective：To explore the clinical effects of PLIF surgery for elderly patients with lumbar degenerative disease. Methods：From March 2010 to May 2013,28 patients with lumbar degenerative disease,aged more than 80 years were treated with PLIF surgery. There were 10 males and 18 females,aged from 80 to 93 years old with an average of（85.44±3.66）years. Course of disease was from 3 to 20 years. The operation time,intra operative blood loss,operation complications were recorded and JOA scores and Macnab criteria were used to evaluate the clinical outcomes. Results：All patients were followed up from 12 to 40 months with an average of 26.5 months. The average operation time was（150.00±26.42） min and the average intra operative blood loss was（373.33±99.88） ml. The pre operative JOA score was 12.30±2.43,and the corresponding postoperative JOA score at the final follow up was 24.81±2.09 which was much higher than the preoperative one（P〈0.01）. According to the modified Macnab criteria to evaluate at the final follow up,16 patients got an excellent result,10 good,2 fair. In the weeks postoperatively,injuries of nerve root happened in 3 cases,superficial wound infection with delayed healing in 3cases,and tear of the dural sac accompanied with cerebrospinal fluid leakage in 1 case. After long term follow up,adjacent segment degeneration and the corresponding spinal canal stenosis occurred in 1 case at 34 months after operation. All cases got successful fusion without any displacement of internal fixation and pseudoarthrosis formation. Conclusion：With proper cases,fully preoperative preparation,perfect intra operative manipulation and active treatment after operation,even advanced ages older than 80 years with lumbar degenerative disease could get satisfactory outcomes after PLIF surgery.