摘要
目的分析腰椎后路减压术个体化应用的临床疗效,优化老年退行性腰椎管狭窄症的后路减压治疗方案。方法回顾性分析我科2009-05~2010-12收治的退行性腰椎管狭窄症患者80例,依据患者病情特点,个体化应用腰椎后路减压术,即分为中央椎板切除减压内固定组35例、全椎板切除减压椎间植骨融合组45例。均于术前及术后12个月进行腰椎JOA评分、Prolo评分及腰腿痛视觉模拟评分（VAS）,并根据JOA评分结果进行疗效分级。结果获得随访75例,时间12-36个月,平均25个月。两组患者术后12个月腰椎JOA评分、Prolo评分及腰腿痛VAS评分结果较术前相比差异均有统计学意义（P〈0.05）。中央椎板切除减压内固定组和全椎板切除减压椎间植骨融合组JOA评分术后改善率依次为77.57%和74.26%。依改善率划分疗效等级,其中优46例,良25例,可4例,优良率94.67%。4例患者术后短期症状加重,经治疗于术后2-5周症状较术前改善;1例患者术后脑梗死,转入神经内科联合治疗后恢复良好;1例患者术后脑脊液漏,治疗后切口甲级愈合。结论腰椎后路减压术治疗老年退行性腰椎管狭窄症安全有效。对于不同的病例,严格制定个体化手术方案,可优化该术式临床疗效。
Objective To evaluate the clinical efficacy of individual application of posterior lumbar decompression and optimize the treatment strategies for senile degenerative lumbar spinal stenosis. Methods A retrospective analysis was conducted in 80 patients from May 2009 to December 2010. Thirty-five patients underwent central vertebral lamina resection,and 45 patients underwent total vertebral lamina resection with intervertebral fusion. All patients were assessed with regard to the lumbar JOA score,Prolo score and visual analogscale（ VAS） of lumbocrural pain before operation and 12 months after operation. The efficiency was evaluated according to the JOA scores. Results Seventy-five patients were followed up for 12- 36 months with an average of 25 months. There was statistical difference in lumbar JOA score,Prolo score and lumbocrural pain VAS before operation and 12 months in two groups（ P〈0. 05）. The improvement rate of lumbar JOA score was 77. 57% in central vertebral lamina resection group and 74. 26% in total vertebral lamina resection with intervertebral fusion group. As a result,46 cases were excellent,25 cases were good,and 4 cases were acceptable,and the excellent and good rate was 94. 67%. Four cases got worse in a short time after operation and completely got better in 2- 5 weeks after operation. One case suffered from cerebral infarction after operation and were immediately transferred to neurology department,as a result,the patient recovered well. One case suffered from cerebrospinal fluid leakage after operation,and the wound healed successfully without infection with the help of active treatment. Conclusion Posterior lumbar decompression in treating senile degenerative lumbar spinal stenosis is safe and effective. For different cases,individual surgical procedure can optimize the clinical effect.
出处
《山西医科大学学报》
CAS
2016年第4期387-392,共6页
Journal of Shanxi Medical University
基金
全军后勤"十二五"重点课题资助项目(CKJ11J020)
关键词
腰椎后路减压术
老年
退行性腰椎管狭窄症
个体化
posterior lumbar decompression
senile
degenerative lumbar spinal stenosis
individualization
