责任节段融合术治疗高龄多节段腰椎管狭窄症

Responsible-segment fusion for multilevel degenerative lumbar spinal stenosis in elderly

[目的]探讨责任节段腰椎融合术治疗高龄多节段腰椎管狭窄症的应用价值。[方法]回顾性分析2014年1月~2017年12月收治的160例高龄多节段退行性腰椎管狭窄症患者。其中,82例减压术后仅行责任节段融合,78例减压术后行常规长节段融合术。比较两组围手术期、随访和影像资料。[结果]两组患者均顺利完成手术。责任节段融合组手术时间、出血量、住院时间均少于多节段融合组,差异有统计学意义(P<0.05)。多节段融合组并发症发生率略高于责任节段融合组,差异无统计学差异(P>0.05)。两组患者术后平均随访(24.59±3.25)个月,随术后时间推移,两组患者的VAS评分、ODI指数均显著下降,而JOA评分明显增加,不同时间点间差异有统计学意义(P<0.05);相同时间点,两组间VAS、ODI和JOA评分的差异均无统计学意义(P>0.05)。至末次随访时,两组患者疼痛、行走、弯腰活动、劳动能力较术前均得到明显改善,生活质量明显提高。影像检查显示随访过程中均未发生螺钉松动、断裂等现象,笼架未出现明显移位及下沉,所有患者均获得骨性融合。[结论]责任节段融合术治疗高龄多节段腰椎管狭窄症能有效地缩短手术时间,减少出血量,缩短住院时间,且能达到预期临床疗效,改善患者生活质量。

[Objective]To evaluate the value of responsible-segment fusion in the treatment of multi-segment lumbar degenerative spinal stenosis in the elderly.[Methods]A retrospective study was conducted on 160 elderly patients who underwent surgical treatment for multi-segment degenerative lumbar spinal stenosis from January 2014 to December 2017.Of them,82 patients had responsible-segment fusion(RSF),while the remaining 78 patients received conventional long-segment fusion(LSF)after decompression.The perioperative,follow-up and radiographic documentations were compared between the two groups.[Results]All the patients had surgical procedures performed successfully.The RSF group had significantly shorter operation time,associated with significantly less intraoperative blood loss and hospital stay than the LSF group(P<0.05).In addition,the RSF group got slightly less complication than the LSF group,which was not statistically significant(P>0.05).As time went during follow up period of(24.59±3.25)months,the VAS and ODI scores significantly decreased,whereas the JOA score significantly increased in both groups(P<0.05).However,there were no statistically significant differences between the two group regarding to VAS,ODI and JOA scores at any matching time point(P>0.05).To the latest follow up,all the patients in both group got significant improvement regarding to pain,ambulation,lumbar motions,quality of life and work capacity compared with those before operation.The radiographic examinations revealed that no loosening or breaking of pedicle screw,and no displacement or subsidence of cage were noticed in any patients of both groups,whereas bony fusion achieved in all of them.[Conclusion]This responsible-segment fusion for multi-segment lumbar spinal stenosis in the elderly does effectively shorten the operation time,reduce bleeding,reduce the hospital stay,and improve quality of life compared with the conventional long-segment fusion.