单纯开窗减压治疗高龄腰椎管狭窄症疗效观察

The curative effect observation of decompression by fenestration merely to treat lumbar spinal stenosis of the elderly

目的:总结单纯开窗减压治疗高龄患者腰椎管狭窄症(lumber spinal stenosis,LSS)的临床疗效。方法:回顾性分析本院2012年2月至2015年10月采用单纯开窗减压治疗42例70岁以上高龄腰椎管狭窄症患者。观察术中出血、手术时间和术后并发症;比较其术前与术后初次下床时、2周、1、3、6、12个月日本骨科协会(Japanese Orthopaedic Association,JOA)腰椎评分、腰痛及腿痛视觉模拟评分(visual analogue score,VAS)和JOA评分改善率来判断临床疗效。结果:所有患者被顺利完成手术,围手术期无难治性并发症。术后初次下床、2周和1、3、6、12个月随访JOA、腰痛和腿痛VAS评分,除腰痛VAS评分术后初次下床时与术前比较差异无统计学意义(P>0.05),其余各时点与术前评分比较差异均有统计学意义(P<0.05)。38例患者完成12个月成功随访,末次随访JOA评分(22.6±2.6),腰痛VAS评分(2.2±0.9),腿痛VAS(2.2±0.7)。JOA评分改善率(71.7±13.4)%,有效率94.7%。结论:对于高龄LSS患者,可充分术前准备后选择单纯开窗减压术。该术式较减压同时固定融合术式减小手术创伤,减少围手术期风险,利于早期康复,并能较好的解除患者痛苦,提高其生存质量。该术式是对于保守治疗无效,有一定手术耐受力又不能耐受同时固定融合的高龄LSS患者的治疗选择方式。

Objective： To summarize the clinical curative effect of decompression by fenestration merely to treat lumbar spinal stenosis（ LSS） of the elderly. Methods： From February 2012 to October 2015,42 cases of LSS of 70 years and the older undergone the decompression by fenestration merely were analyzed retrospectively. The transoperative bleeding,operation time and the postoperative complications were observed. The Japanese Orthopaedic Association（ JOA） scores and Visual Analogue Score（ VAS） of preoperative,the time of getting out of bed for the first time,2weeks,1,3,6,and 12 months postoperative were compared and the improvement rate of JOA to observe the curative effect. Results： All the cases were operated successfully and no one showed difficult complication to deal with.There showed statistically significant of JOA,VAS score of low back pain and skelalgia compared with preoperative and postoperative（ P〈0. 05）,excepting the VAS of low back pain at the time of getting out of bed for the first time（ P〉0. 05）. 38 cases were followedup for 12 months at last,and the score of JOA was（ 22. 6 ± 2. 6）,the VAS of low back pain was（ 2. 2 ± 0. 9） and of skelalgia was（ 2. 2± 0. 7）. The improvement rate of JOA was（ 71. 7 ± 13. 4） percent. The rate of effective treatment was 94. 7 percent. Conclusions： The technique of decompression by fenestration merely can be chosen after sufficient preoperative preparation for the LSS of the elderly.Compared with the fixation with fusion,the more trauma was avoided and the perioperative risk were reduced by this way,which is advantageous to the early rehabilitation. It is better to improve the quality of life owing to relieve the pain by decompression. If there shows no curative effect by expectant treatment,this technique is one of the chosen ways for the LSS of the elderly who has some tolerance to the operation,but they cannot tolerate decompression and posterior Lumbar interbody fusion with fixation.