老年人腰椎管狭窄症的手术治疗46例分析

目的观察新术式多节段椎板开窗、椎管潜行式扩大减压成形术治疗老年人腰椎管狭窄症的疗效，并评价其优缺点。方法采用该术式治疗老年人腰椎管狭窄症４６例，其中退行性２９例，混合性１３例，发育性４例；有３例Ⅰ°腰椎滑脱。结果平均手术时间１个半小时，失血量２２０ｍｌ，平均术后３天下床功能煅练。手术并发症共３例，２例硬脊膜撕裂和１例神经根损伤。４６例随访时间１２～４４个月，平均２５个月。优１９例（４１．３％），良２１例（４５．７％），可６例（１３％），术后无症状加重和病情恶化者。结论结果表明本术式是治疗老年人腰椎管狭窄的一种安全和有效的方法。

An analysis of surgical treatment of 46 cases lumbar spinal stenosis in the elderly

Objective To demonstrate the effectiveness of the new procedure in the treatment of lumbar spinal stenosis in the elderly. Methods From April 1992 to January 1996, 46 consecutive patients with lumbar spinal stenosis underwent multilevel fenestration with undermining enlargement of lumbar canal. There were 28 males, and 18 females, aged 60 to 72 years old, with an average age of 64 years old. The time of follow up ranged from 12 to 44 months, the mean was 25 months. Results Forty of the 46 patients had good results, and the remaining 6 patients had fair results. No patient reported worsening of symptoms postoperatively. Average operative time was 1 5 hours with blood loss 220 ml. Ambulation started three days postoperatively. Complications included two dural matter tears, one nerve root injury, but these were improved within six months postoperatively. Conclusions The multilevel fenestration with undermining enlargement of spinal canal appears to be an efficacious and safe management in the elderly with lumbar spinal stenosis.