老年腰椎手术的围手术期治疗

目的研究合并内科疾病的老年腰椎疾病患者的手术方法及围手术期治疗。方法2000年6月~2003年12月,收治老年腰椎疾病患者125例,年龄60~73岁,平均67岁。其中单纯腰椎间盘突出症23例,腰椎管狭窄症13例,腰椎间盘突出症伴椎管狭窄81例,腰椎滑脱8例。术前对患者进行全面检查,JOA评分11.6±2.5。对合并的内科疾病进行治疗,改善患者状况。手术行椎板开窗髓核摘除术3例,半椎板减压髓核摘除术16例,全椎板减压髓核摘除术82例,全椎板减压髓核摘除及后路固定植骨融合术5例,椎板减压及神经根管减压术11例,腰椎滑脱复位椎弓根系统固定及植骨融合术8例。结果合并内科疾病经有效治疗,对手术产生最小的影响。术后出现应激性溃疡、心绞痛及下肢深静脉血栓形成各1例,经对症治疗痊愈。术后125例获随访3个月~2年6个月,JOA评分提高至26.9±3.1,平均改善率为87.9%。结论早期发现、正确处理围手术期合并内科疾病是保证手术成功的关键,全面的神经定位检查与影像学检查密切结合是防止误诊、漏诊的重要手段。

PERIOPERATIVE TREATMENT FOR SENILE LUMBAR DISEASE ACCOMAPNIED BY INTERNAL DISEASE

OBJECTIVE: To investigate the surgical method and perioperative treatment for senile lumbar disease accompanied by internal disease. METHODS: From June 2000 to December 2003, the complete neurological and physical examinations were performed on the patients before operation, as treatment of internal diseases could improve the patients' conditions. Lumbar operations were performed on 125 patients, among whom 23 had simple lumbar disc herniation, 13 had lumbar spine stenosis, 81 had lumbar disc herniation with lumbar spine stenosis, and 8 had spondylolisthesis. The JOA score was 11.6 +/- 2.5. There were 3 patients undergoing fenerstration + discectomy, 16 undergoing semi-laminectomy + discectomy, 82 undergoing total-laminectomy + disectomy, 5 undergoing total-laminectomy+disectomy+pedicle fixation, 11 undergoing lamina decompression+nerve-root pathyway decompression, and 8 undergoing pedicle screw fixation+bone graft and fusion in spondylolisthesis. RESULTS: With an effective medical treatment, the internal disease produced little effect on the operation. Improved functions and bone fusions were observed after operation. According to the JOA standards, the average alleviation rate was 87.9%. CONCLUSION: Early neurological examination and proper treatment of internal diseases are the keys to the successful operation on the senile patients with lumbar disease. Radiological data are important in avoidance of mistaken diagnosis.