单侧入路双侧减压治疗高龄腰椎管狭窄症的疗效观察

Observation of the clinical effect of the limited spinal canal decompression in elderly patients with lumbar spinal stenosis

中文关键词:  单侧入路  双侧减压  腰椎椎管狭窄症  高龄

英文关键词:Unilateral approach  Bilateral decompression  Lumbar spinal stenosis  Elderly

中文摘要:

  【摘要】 目的：观察与分析高龄腰椎管狭窄患者行单侧入路双侧椎管减压术的临床疗效。方法：回顾性分析2017年3月～2019年9月收治的因腰椎管狭窄症采用有限性椎管减压手术的35例75岁以上的高龄患者，依据手术方式分为传统后正中入路双侧椎板开窗椎管减压术组（A组，n=17，男7例，女10例，平均年龄80.1±3.8岁）及单侧入路双侧有限性椎管减压术组（B组，n=18，男10例，女8例，平均年龄79.9±3.7岁）。观察比较两组患者的手术时间、术中出血量，并采用VAS疼痛评分、JOA评分评估手术疗效。结果：A、B两组间的患者基本情况比较无统计学意义；两组均顺利完成手术。与A组相比，B组患者的手术时间（61.9±17.6min vs 50.4±14.3min）更短，术中出血量（62.6±24.7ml vs 45.4±20.3ml）更少，其差异均具有统计学有意义（P＜0.05）。与术前相比，两组患者术后12个月腿痛VAS评分明显下降，JOA评分明显升高，差异均有统计学意义（P＜0.05），A、B两组间的比较无统计学意义（P＞0.05）。术后12个月两组患者的腰痛VAS评分较术前改善不明显（P＞0.05）。所有患者术后均未发生脊柱不稳定。结论：单侧入路双侧减压治疗高龄腰椎管狭窄症可以获得与开放手术相同疗效，具有时间短、术中出血少、创伤小、不破坏腰椎稳定性的优点。

英文摘要:

  【Abstract】 Objectives: To explore the clinical effect of unilateral approach for bilateral decompression in the treatment of elderly patients with lumbar spinal stenosis. Methods: Data of 35 patients who were elder than 75 years old with lumbar spinal stenosis treated in our hospital from March 2017 to September 2019 were retrospectively reviewed. According to the operation methods, all the patients were divided into group A, in which 17 patients were treated with bilateral lamina fenestration decompression(group A, n=17, 7 males and 10 females with an average age of 80.1±3.8 years), and group B, in which 18 patients were treated with unilateral approach for bilateral decompression(group B, n=18, 10 males and 8 females with an average age of 79.9±3.7 years). The operation time and blood loss were compared between both groups. VAS pain score and JOA score were used to evaluate the efficacy． Results: There was no statistically significant difference of the basic conditions of patients between both groups. Both groups successfully completed the operation. Compared with those in group A, patients in group B had shorter operation time(61.9±17.6min vs 50.4±14.3min) and less intraoperative blood loss(62.6±24.7ml vs 45.4±20.3ml), and the difference was statistically significant(P<0.05). Compared with that preoperatively, the VAS score of leg pain was significantly decreased and the JOA score was significantly increased at 12 months after operation for both groups. The difference was statistically significant(P<0.05) within each group, while that was not statistically significant between groups(P>0.05). The VAS score of low back pain at 12 months after operation did not improve significantly comparing with that before operation(P>0.05). No spinal instability occurred in all patients after surgery. Conclusions: Unilateral approach and bilateral decompression in the treatment of elderly lumbar spinal stenosis can achieve the same curative effect as open surgery, which has the advantages of short time, less intraoperative bleeding, less trauma, and no damage to the stability of the lumbar spine.