【作者】 徐宏兵；

【导师】 杨述华；

【作者基本信息】 华中科技大学 ， 外科学， 2013， 博士

【摘要】 目的分析手术治疗65岁以上老年腰椎管狭窄症病人的可靠性、手术具体方法与术后效果情况。方法对1990年1月至2012年6月我院收治的65岁以上老年腰椎管狭窄症患者673例进行回顾性分析,其病程为3-430个月,平均139.2月,手术治疗的方法主要为全椎板切除减压、多个节段椎板的开窗与减压术、神经根管与全椎板减压+椎弓根螺钉固定术联合椎体间或(和)横突间植骨术。结果19例病人术后症状较术前加重；71例自我感觉与术前无明显差别；未发生术中死亡的病例；582例恢复较好或恢复效果优良,总体优良率为86.5%；结论老年腰椎管狭窄患者的病程长、术前各种并存症多,对手术适应证情况应慎重把握,对病人术前进行详细而全面的检查,同时对并存症进行积极处理,手术成功的关键是各个科室共同协作。在对压迫部分进行充分的减压基础上,手术应尽量减少损伤,并争取于最短时间完成手术,根据实际情况结合恰当的内固定促进植骨融合。术后早期下床活动、积极进行功能练习有助于保证手术效果,也是降低术后并发症发生的关键所在。目的研究老年性的退行性腰椎管狭窄症患者行全椎板切除减压术后腰椎影像学的变化规律。方法收集的73例退行性腰椎管狭窄症进行全椎板切除的病人资料,对术后X线资料进行分析,男37例,女36例,年龄65～87岁,平均73.3岁。术后随访时间5～16年,平均7.3年。对手术节段情况特别是手术相邻节段的上、下椎体间相对距离、椎体间相对位移、椎体间活动角度、椎体间冠状面活动度和椎体间水平面旋转度的改变进行观察。结果146个节段进行全椎板切除减压术的术后同术前进行比较发现,椎体间相对位移轻度增大(P=0.1),椎体间的相对距离有明显降低(P=0.001),椎体间活动角度有增大(P=0.01),椎体间的冠状面活动角度轻度增大(P=0.1),水平面椎体间的相对旋转度增大(P=0.01)。对112个减压节段的相邻上、下节段术前与后资料进行比较发现,上述指标变化情况均不明显(P值均大于0.05)。结论对退行性腰椎管狭窄症的狭窄节段施行全椎板切除减压术,术后X线影像学见手术节段退变征象明显,减压节段相邻的上、下节段退变征象不显著。目的对腰椎后外侧植骨融合术(PLF)、椎间植骨融合术(PLIF)的植骨融合效果进行对比分析研究。方法回顾1996年01月-2011年12月卫生部北京医院骨科收治的行后外侧植骨融合术(PLF)和行腰椎椎体间植骨融合术(PLIF)的腰椎退变性疾病的患者313例；Ⅰ组为PLF组,116例,Ⅱ组为PLIF组,197例。分析融合情况、手术时间、术中失血量及并发症情况,对相关数据进行统计学分析。结果PLF组的融合率为84.5%,PLIF组的融合率为98%。PLF组手术时间为120-480min,平均247.83min; PLIF组手术时间为90-600min,平均240.58min。PLF组手术中出血量为200-4500ml,平均1142.87ml; PLIF组手术出血量机为200-2800ml,平均927.02ml. PLF组术后并发症38例；PLIF组术后并发症36例。两组术后融合情况、手术时间、术中失血量、术后并发症有明显差异,差异有统计学意义(P>0.05)。结论：在植骨融合率与植骨融合等级方面,PLIF优于PLF更多还原

【Abstract】 Objective To evaluate the surgical results of lumbar spinal stenosis in the elderly and to investigate the indications, surgical technical and factors which may contribute to the outcome.Methods This is a retrospective study of673patients aged65and above who had different kinds of decompression laminectomy for lumbar spinal stenosis between1990and2012. The mean age at surgery was71.43years (65-88years old).486cases had co-existing illnesses.62had concomitant degenerative spondylolisthesis.488had spinal instrumentation. Functional result was graded to excellent, good, fair and poor.Results There were86.5%excellent and good,10.5%fair and19cases poor results. Eight patients had re-operations because of post operation hematomas. Multivariate analysis revealed that age, sex, co-morbidity score, number of levels decompressed, and degenerative spondylolisthesis did not predict worse outcomes.Conclusions The surgical results of spinal stenosis in the elderly are favourable and comparable to those reported for the general population.Carefully perioperative preparation is very important in the treatment of old patient’s of lumbar spinal stenosis. Objective To investigate the long-term regularity of the radiology changes of the spine of old patients with degenerative lumbar spinal stenosis after laminectomy through analysis of X-ray data of73patients.Methods The mean age of all patients at surgery was73.3years (range,65-87). The average follow-up period was7.3years (range,5-16years). We analyzed and compared the radiological change of73patients, which consisted of the relative distance and migration between vertebral body, the dynamic vertebral sagittal rotation between flexion and extension, relatively horizontal rotation of the segment, coronal dynamic rotation of the segment.Results There was significant difference between preoperative and postoperative data of the relative distance (P=0.001) between vertebral body and the dynamic vertebral sagittal rotation (P=0.01) and relatively horizontal rotation (P=0.01) of the146segments only treated by laminectomy. No significant difference was found between preoperative and postoperative data of all the index of the112segments up and down adjacent segment treated by laminectomy (P>0.05)Conclusions There was obvious degenerative appearance in the segment by laminectomy of the old patients with degenerative lumbar spinal stenosis after laminectomy. There was no obviously degenerative appearance in the up and down adjacent segment. Objective To analysis fusion effect through comparing lumbar posterolateral fusion (PLF) with posterior lumbar interbody fusion (PLIF).Methods The data of patient who were admitted in Orthopedics of Beijing Hospital of the Ministry of Health were retrospectively analyzed during January1996to December2011. I:PLF group,116cases, II:PLIF group,197cases. We analyze the data of fusion, operative time, operative blood-loss and complications statistically.Results The PLF group fusion rate was84.5%while the PLIF group was98%. The average operative time of PLF group was247.83min (120-480min) while the PLIF group was240.58min (90-600min). The PLF group blood-loss was1142.87ml (200-4500ml); the PLIF group was927.02ml (200-2800ml).38cases of the PLF group developed complications;36cases of the PLIF group developed complications. There are significant differences in fusion, operative time, operative blood-loss, complications, differences between the two groups were were significant statisticallyConclusion PLIF group is better than PLF group on fusion rate and fusion grade.更多还原