老年退行性腰椎椎管狭窄症手术治疗与随访  

Surgical treatment and follow-up outcomes of senile degenerative lumbar spinal stenosis

作　　者：孙常太[1] 张良[1] 王强[1] 王英民[1] 张启维[1] 徐红兵[1] 

机构地区：[1]北京医院骨科,北京100730

出　　处：《脊柱外科杂志》2011年第4期203-206,共4页Journal of Spinal Surgery

摘　　要：目的观察老年退行性腰椎椎管狭窄症行椎管减压、椎弓根螺钉内固定并后外侧植骨的治疗效果。方法 2002年1月～2006年1月获得随访的腰椎椎管狭窄症(不包括各种腰椎滑脱)患者241例,行椎管减压、椎弓根螺钉内固定并横突间植骨。观察术后并发症和死亡情况,应用Oswestry功能障碍指数(Oswestry disability index,ODI)和疼痛视觉模拟量表(visual analogue scale,VAS)分别对术前、术后1年及随访时的临床效果进行评分。比较患者术后即刻、6个月及1年及腰椎X线片,通过相邻横突间骨小梁的形成情况进行融合效果判断,并比较融合和未融合病例的手术效果。结果术后2例发生脑梗塞,其中1例发生脑干梗塞死亡的严重并发症。2例心绞痛发作,2例心肌梗死,1例心衰,5例心血管并发症者经纠正后均康复。8例发生脑脊液漏经处理后7例很快闭合,1例发生感染经抗感染处理后康复。3例发现椎弓根螺钉置入位置有误,其中1例出现拇指伸指肌力减退的并发症,其余未出现并发症。双节段手术时间平均为2.8 h,手术出血量平均480.4 mL。手术后无明显并发症的患者均能在术后1周佩戴护腰下床活动,平均3个月能恢复日常活动能力。患者术后1年及末次随访时的ODI、腰痛VAS评分及腿痛VAS评分与术前相比明显降低,差异有统计学意义(P<0.05)。随访1年植骨融合率为42.1%,无明显椎弓根螺钉的松动和拔除。植骨融合者与未融合者ODI差异无统计学意义(P>0.05)。结论老年退行性腰椎椎管狭窄症患者非手术治疗无效,经过术前身体状况严格评估无手术禁忌证可以考虑手术治疗。广泛椎管减压、椎弓根螺钉内固定并后外侧植骨可以取得非常满意的临床效果。植骨融合率与术后效果无明显关系。Objective To determine the effects of surgical decompression and pedicle screw internal fixation for senile degenerative lumbar spinal stenosis.Methods During January 2002 to January 2006,241 patients of lumbar spinal stenosis（excluding those with various spondylolisthesis） received decompression,pedicle screw internal fixation,and posterolateral bone grafting in our department.Postoperative complications and deaths were observed.Oswestry disability index（ODI） and visual analogue scale（VAS） were used to evaluate the patients＇ condition preoperatively,1 year postoperatively and at the end of follow-up.Lumbar reontgenographs were observed immediately,6 months and 1 year after the operation and at the final follow-up.Trabecular bone formation between adjacent transverse processes was observed to evaluate bone fusion.The postoperative effects were compared between the fusion and non-fusion cases.Results There were 2 cases having cerebral infarction postoperatively,and 1 of them died of brainstem infarction.There were 5 cases of cardiovascular complications,including 2 cases of angina pectoris attacks,2 cases of myocardial infarction,and 1 case of heart failure.All of them were rehabilitated after corresponding treatment.Eight cases had cerebrospinal fluid leakage,7 of them were closed soon after the treatment,and the left 1 case had cerebrospinal fluid infection and had rehabilitation after antibiotic treatment.Pedicle screw misplacements were found in 3 cases,and no complication was found except for 1 case had diminished muscle strength of hallux extensor.For 2 segment operation,the operating time was 2.8 hours averagely,and surgical bleeding was 480.4 mL.All patients without complications were able to walk in 1 week after the operation with aid of wearing corset,and resumed daily activity after 3 months.For all 241 cases,at 1 year postoperative and the final follow-up ODI,low back pain and leg pain VAS scores were significantly lower than those preoperatively（P〈0.05）.Graft fusion rate was 42.1%

关 键 词：老年人 腰椎 椎管狭窄 脊柱融合术 内固定器 

分 类 号：R681.533.2[医药卫生—骨科学]