老年退行性腰椎管狭窄症手术治疗的疗效分析

目的探讨老年退行性腰椎管狭窄症患者手术治疗的疗效。方法1994年1月~2006年11月收治的247例65岁以上退行性腰椎管狭窄症患者中168例获得0.5~5年随访;把病例分为非固定组111例(全椎板切除减压或 横突间植骨、小开窗切除或半椎板减压)和固定组57例两组。将两组中各种术式的疗效进行回顾性分析。结果无死亡病例。发生并发症者30例。JOA评分优良率,非固定组为92.1%,固定组为94.3%。结论对于老年退行性腰椎管狭窄症的患者,没有明确证据证明腰椎不稳时,治疗以单纯减压为主,双侧小开窗或单侧小开窗 对侧半椎板减压可以满足绝大多数患者的要求,手术方法应人而异。内固定组与非固定组疗效经标准化处理无明显差异。但非固定组的治疗费用远远低于内固定组。

Surgical treatment for degenerative lumbar spinal stenosis in old patients

Objective To discuss the effect of surgical treatment for degenerative lumbar spinal stenosis in old patients. Methods From Jan.1994 to Nov.2006, 247 patients with degenerative lumbar spinal stenosis over 65 years old received surgical treatment at our department. Among them, 168 patients were followed up with a period of 6 months to 5 years. The patients were divided into two groups: non-fixation group (n=111), in which patients had laminectomy and posterior-lateral bone grafting, open-window decompression or hemilaminectomy; fixation group (n=57). The surgical outcomes were retrospectively analyzed. Results Thirty patients had a kind of postoperative complications and no patients died during the follow-up. The excellent and good rate of JOA score was 92.1% for non-fixation group and 94.3% for fixation group. Conclusion Decompression without fixation could provided satisfactory results for the old patients with degenerative lumbar spinal stenosis without lumbar instability. Bilateral open-window decompression or unilateral open-window decompression with hemilaminec-tomy at the opposite side could be chosen for different patients. There is no significant difference in surgical outcome between non-fixation group and fixation group. However, the therapeutic cost of non-fixation group is far lower than that of fixation group.