老年退行性腰椎管狭窄症的外科治疗  

Surgical therapy for degenerative lumbar spinal canal stenosis in the elderly

作　　者：夏庆[1] 陈统一[1] 姜晓辛[1] 王晓峰[1] 

机构地区：[1]复旦大学附属中山医院骨科,上海200032

出　　处：《老年医学与保健》2007年第4期240-242,共3页Geriatrics & Health Care

摘　　要：目的探讨外科治疗老年退行性腰椎管狭窄症的方法及疗效。方法回顾性分析2003年2月至2006年4月中山医院骨科收治的70岁及以上退行性腰椎管狭窄症患者137例,男92例,女45例;年龄70～81岁,平均75.6±6.2岁;病史3～8年,平均5.3±0.4年。41例患者术前合并一种或多种内科疾病,所有病人术前均经内科治疗,病情稳定3个月以上后方行手术。112例行单纯全椎板或部分椎板切除减压术;25例采用椎板减压＋椎弓根固定＋椎间植骨融合术。结果围手术期并发症12例,经对症处理及内科联合治疗后好转,无围手术期死亡病例。本组平均随访时间2年6个月,Oswestry评分术前为62.42±11.36,术后为17.25±5.62。所有患者术后神经受压症状均有改善,连续行走从术前不足15min到术后至少30min。结论手术治疗有助于老年退行性腰椎管狭窄症患者神经功能的恢复,术前积极治疗合并症可以降低围手术期风险。Objective To investigate the modality and outcome of surgical treatment for degenerative lumbar spinal canal stenosis in elderly patients. Methods From February 2003 to April 2006, a retrospective review of 137 cases of degenerative lumbar canal stenosis treated surgically was performed. They included 92 males and 45 females ranging in age from 70～81 years with a mean of 75.6 years, whose history ranged from 3 to 8 years with a mean of 5.3 years. Of these patients, 41 patients suffered from one or more types of morbus internus concomitantly. All patients had received medical treatment before surgical treatment. Surgical modalities included simple surgical decompression in 112 cases, and posterior decompression combined with pedicle screws fixation and posterolateral bone graft in the remaining 25 cases. All patients were followed up for 1.5-3.1 years. Results No death occurred. Perioperative complications occurred in 12 cases, which were relieved after symptiomatic treatment. Oswestry score improved from preoperative 62.42±11.36 to postoperative 17.25±5.62. The continuous motor function improved in all cases from no more than 15min preoperationally to at least 30min postoperationally. Conclusions Surgical intervention is of great significance in helping the recovery of neurological function of elderly patients with degenerative lumbar canal stenosis. Positive preoperative treatment of complications is helpful in reducing perioperative risks of such patients.

关 键 词：腰椎 椎管狭窄 老年人 椎板切除术 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]