高龄腰椎退行性疾病患者后路减压融合手术的疗效及并发症

The effect and complications of posterior lumbar decompression and fusion in geriatric patients with lumbar degenerative disease

中文关键词:  腰椎退行性疾病  腰椎后路减压融合术  高龄  并发症

英文关键词:Lumbar degenerative disease  Posterior lumbar decompression and fusion  Geriatric  Complications

中文摘要:

  【摘要】 目的：分析高龄腰椎退行性疾病患者后路减压融合手术的疗效及并发症。方法：2015年1月~2018年10月共计268例年龄≥75岁患者因腰椎退行性疾病在我院接受腰椎后路减压融合手术，其中随访时间不少于12个月且有完整随访资料的患者230例纳入本研究。随访时间为12~51个月（23.4±8.0个月）。患者年龄为75~84岁（77.3±2.2岁），单节段手术60例，两节段手术114例，三个及以上的节段手术56例。192例（83.5%）患者有术前合并症，平均每例患者合并有2.2种内科疾病，其中合并高血压病176例（74.6%）、糖尿病88例（38.3%）、心脏疾病48例（20.9%）、脑梗死30例（13.0%）、肺部疾病26例（11.3%）、肿瘤18例（7.8%）；术前联系相关内科会诊次数共计302次，平均每例患者术前会诊1.3次。为明确责任节段，70例（30.4%）患者术前进行了神经根阻滞术，其中24例（10.4%）患者进行了2次及以上的神经根阻滞术。收集患者的手术时间、术中出血量以及术后并发症情况；术前、术后3个月及末次随访时采用疼痛视觉模拟评分（visual analogue scale，VAS）和Oswestry功能障碍指数（Oswestry disability index，ODI）进行评估。结果：230例患者均完成手术，出院。手术时间为120~380min（233.1±67.3min），术中出血量为150~600ml（304.5±92.4ml）。患者术前腰痛和下肢痛VAS评分分别为7.2±1.2分和6.6±1.7分、术后3个月分别为3.4±0.5分和3.3±0.5分、末次随访时分别为1.8±0.4分和1.7±0.5分，术前ODI为（57.1±10.5）%、术后3个月为（19.3±3.0）%、末次随访时为（11.4±1.7）%，术后3个月及末次随访时的VAS评分及ODI较术前均明显改善（P＜0.05）。术后总体并发症发生率为28.7%，其中手术相关并发症30例（13.0%），硬膜撕裂14例，切口愈合不良8例，脑脊液漏6例，切口感染1例，神经根损伤1例（因钉位欠佳，调整后1周内恢复）；非手术相关并发症36例（15.7%），肠梗阻12例，泌尿系感染8例，尿潴留6例，坠积性肺炎4例，脑梗死4例，深静脉血栓2例；末次随访2例患者出现螺钉松动，未出现螺钉、钛棒断裂。结论：75岁及以上的高龄患者术前合并症较多、围手术期准备更加繁复、术后并发症发生率高。在系统的术前准备基础上，高龄腰椎退行性疾病患者通过手术治疗可以获得满意疗效。

英文摘要:

  【Abstract】 Objectives: To evaluate the effect and complications of posterior lumbar decompression and fusion in geriatric patients with lumbar degenerative disease by retrospective analysis of the medical data. Methods: From January 2015 to October 2018, a total of 268 patients aged 75 and above received lumbar posterior decompression and fusion surgery due to lumbar degenerative diseases in our hospital. Among them, 230 patients were followed up for no less than 12 months(12-51 months, a mean of 23.4±8.0 months) with complete follow-up data. The average age of the patients was 77.3±2.2 years old(ranged 75-84 years old). There were 60 cases of single segmental surgery, 114 cases of two segmental surgery, and 56 cases of three or more segmental surgery. 192 patients had preoperative complications(83.5%). Each patient had 2.2 kinds of medical disease on average, with hypertension in 176(74.6%) patients, diabetes in 88(38.3%) patients, heart diseases in 48(20.9%) patients, cerebral infarction in 30 (13.0%) patients, pulmonary diseases in 26 (11.3%) patients, and tumor in 18(7.8%) patients. A total of 302 times of preoperative medical consultation were conducted, with an average of 1.3 times for each patient. 70 patients(30.4%) underwent root block before surgery required by their diagnoses, of which 24(10.4%) underwent two or more root block. Operation time, intraoperative blood loss and postoperative complications were collected. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used for evaluation at pre-operation, 3 months after surgery and final follow-up. Results: All 230 patients were operated and discharged. The operation time was 120-380min (range, 233.1±67.3min), and the intraoperative blood loss was 150-600ml(range, 304.5±92.4ml). At pre-operation, the VAS score of waist was 7.2±1.2 points, and 6.6±1.7 points of lower limb. At 3 months after surgery, the VAS score of waist was 3.4±0.5 points, and 3.3±0.5 points of the lower limb. At final follow-up, the VAS score of waist was 1.8±0.4 points, and 1.7±0.5 points of the lower limb. The preoperative ODI was (57.1±10.5)%. At 3 months after surgery, the ODI score was (19.3±3.0)%, and at final follow-up it was (11.4±1.7)%. The postoperative VAS score and ODI were significantly improved compared with that preoperatively(P<0.05). The overall incidence of postoperative complications was 28.7%, with 30 cases (13.0%) of operation-related complications, which included 14 cases of dural tear, 8 cases of poor incision healing, 6 cases of cerebrospinal fluid leakage, 1 case of incision infection, and 1 case of nerve root injury (due to poor screw position, recovery after adjustment). 36 cases(15.7%) of non-surgical complications, including 12 cases of intestinal obstruction, 8 cases of urinary tract infection, 6 cases of urinary retention, 4 cases of pendular pneumonia, 4 cases of cerebral infarction, and 2 cases of deep vein thrombosis. At final follow-up, no screw and titanium rod fracture found besides 2 patients showed screw looseness. Conclusions: Patients aged 75 years or above with lumbar degenerative diseases have more preoperative complications, more complicated perioperative preparation and higher incidence of postoperative complications. On the basis of systematic preoperative preparation, patients aged 75 years or above with lumbar degenerative diseases can obtain satisfactory results through surgical treatment.