选择性开窗减压术对高龄患者多节段腰椎管狭窄症的疗效研究

目的对选择性开窗减压手术治疗80岁以上高龄患者多节段腰椎管狭窄症的疗效进行评价。方法手术采用后正中入路,术前根据患者症状、查体与影像学检查准确定位病灶,进行选择性开窗减压手术治疗;采用JOA评分法评价手术疗效。结果于术后近期(6个月内)对患者进行随访,随访患者52名,应答率100%。于术后中期(24~36个月)对患者进行随访,随访患者47名,应答率90.4%,平均随访时间30.4个月。JOA术前评分为(6.93±0.52)分,术后近期JOA评分为(11.98±0.72)分,其中40例(76.9%)达到优,10例(19.2%)达到良,2例(3.9%)达到可,优良比例达到96.1%。术后中期JOA评分(12.06±0.46)分,其中36例(76.6%)达到优,10例(21.3%)良,1例(2.1%)可,优良比例达到97.9%。术后近、中期JOA评分与治疗前JOA评分比较,差异具有统计学意义(P0.01),术后近、中期JOA评分之间差异无统计学意义(P0.05)。结论选择性开窗减压术具有创伤小、恢复时间短等特点,在LSS高龄患病者这一群体中的疗效满意,是适合这一群体的治疗方法。

Effect of selective fenestration decompression for elderly patients with lumbar spinal canal stenosis

Objective To evaluate the curative effect of selective window decompression surgery for over 80-year-old patients with mul-tiple segment lumbar spinal stenosis. Methods The patients received the operation through posterior median approach. The location of le-sions were determined according to patients＆#39; symptom,physical examination and imaging examination,the selective window decompression sur-gery was performed in patients,JOA scoring method was used to evaluating the effect of surgery. Results In the recent follow-up of first 6 months after surgery,the response rate of 52 patients with follow-up was 100%. During the mid-term follow-up after 24-36 months,the re-sponse rate of 47 patients with follow-up is 90. 4%,the average follow-up time was 30. 4 months. The preoperative JOA score and postopera-tive score were （6. 93 ±0. 52） and （11. 98 ±0. 72） respectively,of which 40 cases achieved optimal standard （76. 9%）,10 cases （19. 2%） achieved a good standard,2 cases reached the standard （3. 9%）,the excellent rate was 96. 1%. The JOA score of mid-term fol-low-up was （12. 06 ±0. 46）,of which 36 cases reached optimal standard （76. 6%）,10 cases achieved a good standard （21. 3%）, but standard was in 1 case （2. 1%）,the excellent rate was 97. 9%. The difference of JOA scores was statistically significant （P〈0. 01）. Con-clusion Selective windowing decompression has the advantages of small trauma,short recovery time and satisfied curative effect,which is suitable for elderly patients with lumbar spinal stenosis.