老年腰椎退行性疾病患者不同手术疗效的比较

目的评估老年腰腿痛患者单纯开窗减压与开窗减压椎间植骨结合内固定2种手术的治疗效果。方法回顾性分析70例老年腰腿痛患者的病历资料,所有患者均存在明显腰椎椎管狭窄。按照手术方式分为A、B 2组。A组28例,单纯开窗减压手术,患者一般合并普通疾病2或3个,手术节段3.26±0.42;B组42例,采用开窗减压椎间植骨结合椎弓根螺钉系统内固定手术,患者一般合并普通疾病2或3个,手术节段2.44±0.63。分析患者住院期间以及出院1年以后症状改善情况,结合问卷调查患者对治疗的满意程度,比较老年腰腿痛患者不同治疗方法的治疗效果。结果 2组患者术后腰腿痛均得到明显缓解,生活质量显著提高。2组患者的满意率分别为82.2%和71.5%。但是在手术时间、手术中出血量、术后引流量等方面,2组间均存在显著差异,差异具有统计学意义（P〈0.05）。结论对于老年腰腿痛患者,腰椎单纯后路开窗减压、后路开窗减压内固定手术后腰腿痛均得到明显缓解、生活质量显著提高,单纯开窗减压手术可以显著缩短手术时间、减少术中出血量、减少术后引流量,手术安全性更高。     

后路椎间盘镜显微治疗腰椎椎管狭窄症

目的 报道显微后路椎间盘镜治疗退行性腰椎椎管狭窄症的临床效果。方法 选取退行性腰椎管狭窄症病例，椎板间隙入路椎间盘镜下行椎管减压，单侧单节段开窗减压23例，双侧单节段开窗减压12例，单侧双节段开窗减压9例，单侧双节段半椎板切除减压4例。结果 除1例术中硬膜破裂改常规手术外，其余病例均在手术显微镜下完成腰椎管减压术。所有病例获得5～18个月随访，平均8．3个月，优良率92％。结论 显微后路椎间盘镜治疗退行性腰椎管狭窄症具有手术创伤小、神经根减压彻底、术后恢复快的特点；单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是其适应证。     

有限减压手术方式治疗退行性腰椎管狭窄症的疗效分析

目的观察有限减压手术治疗退行性腰椎管狭窄症的中远期疗效。方法98例退行性腰椎管狭窄症患者根据病理改变情况,分别采用三种手术方法(腰椎间盘镜下减压术、后路椎板开窗减压术与椎管环形减压术)进行有限减压。其中腰椎间盘镜下减压术29例,后路椎板开窗减压术22例,椎管环形减压术47例。所有患者未做融合及内固定术。采用Nakai分级结合腰椎正侧+动力位X线片所见,制定手术疗效判定标准。结果随访18个月~66个月,平均36.4个月。优86例(87%),良12例(13%),差0例(0%)。随访未发现手术节段失稳者。结论有限减压手术方式治疗不合并腰椎不稳及腰椎滑脱的退行性腰椎管狭窄症可取得良好的中远期疗效。     

单纯减压与减压后融合治疗单纯退变性腰椎管狭窄症疗效对比研究

【摘要】 目的 比较单纯椎管减压术和减压后器械内固定融合治疗无腰椎滑脱和失稳的退变性腰椎管狭窄症的临床疗效。方法 自2006年3月~2011年5月期间,在我院接受手术治疗的单纯退变性腰椎管狭窄症患者共63例,其中接受单纯选择性椎管减压术治疗的患者28例,接受椎管减压加器械内固定融合手术患者35例。手术前后分别使用腰椎JOA (Japanese Orthopedic Association) 评分、ODI(Oswestry Disability Index)评分和SF?鄄36(Short Form?鄄36)评分,评估两种术式的临床疗效。结果 两组患者术后1年均取得较好疗效。其中椎管减压加融合组患者术后ODI评分改善31.2分(P<0.001),由重度功能障碍改善至轻度功能障碍;单纯选择性椎管减压组术后ODI评分改善14.9分(P=0.004),由重度功能障碍改善至中度功能障碍;减压加融合组预后较单纯减压组显著改善(P<0.01),术后SF?鄄36评分得到相似结果。结论 手术治疗能极大地改善腰椎管狭窄患者的临床症状,椎管减压加融合术较单纯椎管减压术能更大程度改善该类患者的临床症状。     

后路椎间盘镜在治疗腰椎管狭窄症中的应用

目的：探讨后路椎间盘镜在治疗腰椎管狭窄症中的应用。方法：2000年2月--2001年12月退行性腰椎管狭窄症142例行后路椎间盘镜下椎管有限减压、全椎板或半椎板切除减压、开窗减压术。结果：应用后路椎间盘镜行椎管有限减压87例，减压松解充分。82例随访平均18月，优良率92．7％(优58例，良18例)。无并发症。结论：单纯腰椎间盘膨出或突出、黄韧带肥厚和小关节增生引起的退行性腰椎管狭窄症是后路椎间盘镜下椎管有限减压的适应证。满意的手术效果取决于：病人选择适当，术中操作精细，减压彻底。     

内窥镜下有限减压治疗老年退变性腰椎管狭窄症

目的观察后路显微内窥镜下有限减压治疗老年退变性腰椎管狭窄症的临床疗效。方法自2007年5月至2011年6月,后路显微内窥镜下有限减压治疗下腰椎管狭窄症36例,通过术前、术后1周、术后6个月与末次随访时进行Oswestry功能指数比较以确定手术疗效,记录所有患者手术相关并发症。结果手术时间35～140min,平均65rain;术中出血30～280mL,平均120mL。随访时间6～45个月,平均26个月。术后3次Oswestry功能指数与术前比较均有统计学差异（P〈O．01）。结论后路显微内窥镜下有限减压治疗老年退变性腰椎管狭窄症创伤小,恢复快,减压充分,对腰椎后柱结构破坏小,同时可以获得良好疗效。     

老年腰椎手术的围手术期治疗

目的研究合并内科疾病的老年腰椎疾病患者的手术方法及围手术期治疗。方法2000年6月~2003年12月,收治老年腰椎疾病患者125例,年龄60~73岁,平均67岁。其中单纯腰椎间盘突出症23例,腰椎管狭窄症13例,腰椎间盘突出症伴椎管狭窄81例,腰椎滑脱8例。术前对患者进行全面检查,JOA评分11.6±2.5。对合并的内科疾病进行治疗,改善患者状况。手术行椎板开窗髓核摘除术3例,半椎板减压髓核摘除术16例,全椎板减压髓核摘除术82例,全椎板减压髓核摘除及后路固定植骨融合术5例,椎板减压及神经根管减压术11例,腰椎滑脱复位椎弓根系统固定及植骨融合术8例。结果合并内科疾病经有效治疗,对手术产生最小的影响。术后出现应激性溃疡、心绞痛及下肢深静脉血栓形成各1例,经对症治疗痊愈。术后125例获随访3个月~2年6个月,JOA评分提高至26.9±3.1,平均改善率为87.9%。结论早期发现、正确处理围手术期合并内科疾病是保证手术成功的关键,全面的神经定位检查与影像学检查密切结合是防止误诊、漏诊的重要手段。     

椎弓根螺钉置入联合双侧椎板开窗减压术对腰椎管狭窄症并不稳患者腰椎功能的影响

目的 探析在腰椎管狭窄症并不稳患者中采用椎弓根螺钉置入联合双侧椎板开窗减压术治疗对腰椎功能的影响。方法 选择2019年3月—2022年3月诊治的56例腰椎管狭窄并不稳患者进行回顾性分析,根据手术方式不同将其分为两组,对照组(n=28,行开放椎弓根螺钉内固定术)和观察组(n=28,行椎弓根螺钉置入+双侧椎板开窗减压术)。采用日本骨科协会评估治疗分数(JOA)、Oswestry功能障碍指数(ODI)评分评估两组术后腰椎功能,统计两组临床效果优良率。结果 观察组术后6个月的JOA评分高于对照组,且ODI评分低于对照组(P<0.05);观察组临床效果优良率为92.86%,高于对照组的67.86%(P<0.05)。结论 采用椎弓根螺钉置入、双侧椎板开窗减压术联合治疗腰椎狭窄症并不稳患者,可获得良好的临床效果,改善其腰椎功能。     

椎板开窗撑开潜行式减压手术治疗腰椎管狭窄症

目的探讨椎板开窗撑开潜行式减压手术治疗腰椎管狭窄症的临床疗效。方法回顾自2004年3月至2007年4月采用椎板开窗撑开潜行式减压手术治疗腰椎管狭窄症26例。结果本组无硬膜囊撕裂和脑脊液漏等手术并发症。根据北美脊柱外科学会的腰椎功能障碍指数(ODI)进行疗效评分[1]:术后1年以上随访,其中:优19例,良5例,改善2例,疗效优良率为92.31%。X线检查未发现腰椎不稳和滑脱的现象。结论椎板开窗撑开潜行式减压手术是治疗腰椎管狭窄症行之有效的方法之一。     

腰椎管狭窄的治疗进展

随着我国人口老龄化加剧,以退行性改变为主的腰椎管狭窄症患者不断增多。腰椎管狭窄目前没有足够的证据推荐任何特定类型的非手术治疗,手术是治疗腰椎管狭窄的有效方法,腰椎管狭窄患者不经过保守治疗而采用手术改善临床症状具有最强的证据基础。单纯减压术后脊柱节段不稳促使融合技术的发展,融合后相邻节段退变加速、症状不缓解导致动态固定技术应运而生。患者在行椎管减压的同时是否需植骨融合至今仍存在较大争议,近年来我国治疗腰椎管狭窄的单纯减压手术明显下降,然而减压加融合手术却持续增加。椎管减压同时辅以腰椎融合,越来越多被应用于腰椎管狭窄来减少脊柱不稳和畸形的潜在风险。虽然减压手术治疗是有一定的临床效果,但目前尚不清楚是否减压附加融合手术的结果要优于单纯减压手术。本文对腰椎管狭窄患者是否需要融合进行综述研究,旨在进一步探讨腰椎管狭窄手术治疗的最佳选择,专注于以证据为基础的治疗方案。     

Does obesity affect the results of lumbar decompressive spinal surgery in the elderly?

The prevalence of obesity among the population is increasing, including in many elderly people. The purpose of this study was to evaluate whether lumbar spinal surgery in elderly patients with different body mass indices influences pain, satisfaction rate, and activities of daily living. Two hundred ninety-eight elderly patients (older than 65 years), 153 women and 145 men, who had decompressive laminectomy, discectomy, or combinations of these procedures during 1990 to 2000 were followed up. Indications for surgery included limitation in doing activities of daily living, severe pain, or both. The patients were classified into one of four categories in terms of their body mass index. The operative parameters, pain reduction, satisfaction rate, and activities of daily living using the Barthel index were assessed. The more obese patients were younger, tended to be female, and were more symptomatic. All four groups of patients had reduction in pain, improvement in activities of daily living, and were satisfied with the operation. Our data suggest that it is reasonable to operate on patients who are elderly and obese and who have lumbar symptoms, with the appropriate indications.     

Decompression surgery for lumbar spinal stenosis in the elderly: preoperative expectations and postoperative satisfaction

STUDY DESIGN: Retrospective cohort examination. OBJECTIVES: Data on expectations and satisfaction rates in elderly patients operated for lumbar spinal stenosis (LSS) are limited. The present study aimed to investigate these issues as well as the factors that might affect them. SETTING: A university affiliated hospital. PATIENTS AND METHODS: A follow-up study of 367 consecutive patients aged 65 years and older (mean age 71.4 years), who underwent surgery for degenerative LSS between 1990 and 2000. Data collection included patients' preoperative expectation, demographic data, body mass index, operative risk, duration of symptoms, clinical presentation and patients' satisfaction on follow-up, pain level, activities of daily living level and walking ability. Data were recorded before operation and on follow-up. Preoperative and follow-up data were analyzed by univariate and multivariable models. RESULTS: The response rate on follow-up was 81% (298 patients). A logistic regression analysis showed that advanced age, male gender and high education level were independently associated with positive expectations, while a great number of covariates were associated with patients' satisfaction. High patients' expectations were positively interrelated with satisfaction (r=0.332, P<0.001). CONCLUSIONS: In the elderly, preoperative expectations reasonably predict their postoperative satisfaction rate. It is suggested that a greater effort should be made to narrow the gaps between expectations and satisfaction, perhaps by providing more accurate preoperative information data regarding the outcomes of planned surgery.     

微创手术治疗单节段腰椎管狭窄症的疗效评价

目的:对比微创手术与传统开放手术治疗单节段腰椎管狭窄症的临床效果,评价微创手术治疗腰椎管狭窄症的安全性和有效性。方法:2008年1月～2009年1月收治43例单节段腰椎管狭窄症患者,其中28例采用传统开放减压、后路椎体间融合手术(posterior interbody fusion,PLIF)治疗(A组),15例采用微创减压、经椎间孔融合手术(transforaminal lumbar interbody fusion,TLIF)治疗(B组),比较两组患者的手术时间、术中C型臂X线机照射时间、术中出血量、术后引流量、术后下地时间和术后平均住院时间,并分别采用Oswestrydisability index(ODI)、visual analogue scores(VAS)和X线评价治疗效果。结果:所有患者均获得随访,两组术前一般资料、VAS和ODI评分无显著性差异。B组手术时间和术中透视时间多于A组(P<0.01),而术中出血量和术后引流量B组明显低于A组(P<0.01),术后下地活动时间和术后平均住院日B组明显短于A组(P<0.01)。术后5d时VAS评分B组优于A组(P<0.05),而其他时间相比两组VAS评分与ODI评分相比均无显著性差异(P>0.05),术后X线评价融合率两组亦无显著性差异(P>0.05)。结论:与传统开放手术相比,微创手术治疗单节段腰椎管狭窄症,同样可以获得安全、有效的治疗结果,并且在手术出血量、术后引流量、术后下地活动时间和术后住院时间方面优于传统开放手术。     

退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略

目的退变性腰椎侧凸合并椎管狭窄多为中老年患者,治疗方法选择复杂。探讨退变性腰椎侧凸合并椎管狭窄的阶梯性治疗策略及疗效。方法 2005年1月-2009年12月,收治退变性腰椎侧凸合并椎管狭窄患者117例,根据患者意愿、内科合并症、腰腿痛症状、腰椎侧凸后凸旋转三维畸形、腰椎稳定性的情况(侧方滑移、退变性滑脱),以及脊柱整体平衡状态,阶梯性地选择保守治疗(43例)、后路单纯减压术(18例)、后路短节段融合术(1～2个节段,41例)、后路长节段融合畸形矫正(≥3个节段,15例)方法治疗。比较患者治疗前后腰痛及腿痛的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、腰椎前凸角、侧凸Cobb角的变化。结果术后获1年以上随访72例;无死亡及内固定失败。保守治疗19例平均随访19.3个月(1～5年),无症状加重,末次随访时腰痛及腿痛VAS评分、ODI较治疗前明显降低(P<0.05),腰椎前凸角减小、侧凸Cobb角增大,但与治疗前比较差异无统计学意义(P>0.05)。后路单纯减压术12例平均随访36个月(1～5年),末次随访时腿痛VAS评分、ODI较治疗前均明显降低(P<0.05),腰痛VAS评分较治疗前减小,但差异无统计学意义(P>0.05);腰椎前凸角减小、侧凸Cobb角增大,但进展缓慢,与治疗前比较差异无统计学意义(P>0.05)。后路短节段融合31例平均随访21.3个月(1～3年),术后发生血肿、切口愈合不良、脑脊液漏、浅表感染各1例,经对症处理后治愈;末次随访时腰痛及腿痛VAS评分、ODI较治疗前均明显降低(P<0.05),腰椎前凸角及侧凸Cobb角均明显改善(P<0.05)。后路长节段融合10例平均随访17.1个月(1～3年),术后症状加重1例,经理疗及药物治疗3个月后缓解;术后深部感染1例,经清创切口持续冲洗引流后治愈;末次随访时腰痛及腿痛VAS评分、ODI、腰椎前凸角及侧凸Cobb角均较治疗前明显改善(P<0.05)。结论退变性腰椎侧凸合并椎管狭窄的治疗应个体化、阶梯性地选择治疗方案。手术治疗以减压为主、矫形为辅,应准确判断症状责任节段、侧凸责任节段、后凸责任节段,防止手术扩大化,积极控制出血,提高手术安全性。     

腰椎退变性侧凸的治疗策略

目的探讨非手术治疗或腰椎后路减压、矫形固定、融合手术治疗由于椎间盘退变后继发小关节退变、椎管和神经根管容积变化以及脊柱失稳、畸形等病理改变导致的腰椎退变性侧凸患者的效果。方法2001年7月-2007年6月，治疗退变性腰椎侧凸患者56例，其中行非手术治疗5例。手术治疗51例。手术组患者平均年龄为63岁，腰椎侧凸Cobb角平均30°，采用腰椎后路减压，或辅助椎弓根螺钉矫形固定、后外侧融合或椎间融合治疗。结果56例均得到随访，平均随访时间为20个月，非手术治疗和手术患者均对治疗效果满意，生活质量提高，手术组矫正角度平均为15°，骨融合率达到95％，无神经损伤及翻修病例。结论腰椎退变性侧凸首选非手术治疗，如失败应根据患者情况遵循尽量采用有限内固定和融合的原则行手术治疗。     

Results of surgery for spinal stenosis adjacent to previous lumbar fusion

The literature provides little data to guide surgical management of spinal stenosis adjacent to previous lumbar fusion. Thirty-three consecutive patients who had surgical decompression for spinal stenosis at the lumbar segments adjacent to a previous lumbar fusion were studied. The mean interval between fusion and the adjacent segment surgery was 94 months. Of the 33 patients, 26 were followed for 3-14 years (mean: 5 years) after adjacent segment surgery and were clinically evaluated and independently completed an outcome questionnaire. Of the 26 patients, 15 rated their outcome as completely satisfactory, 6 were neutral toward the surgery, and 5 considered their surgery a failure. The surgery was generally effective at improving or relieving lower extremity neurogenic claudication. The strongest independent predictive factor of patient dissatisfaction was ongoing postoperative low back pain (r = 0.7, p = 0.001). A higher back pain score at follow-up was associated with continued narcotic use (p = 0.001) and decreased ability to perform activities of daily living (p = 0.05). Six patients required further lumbar surgery during the follow-up period. This study provides the longest published follow-up data of surgical results for symptomatic spinal stenosis adjacent to a previously asymptomatic lumbar fusion.     

Gender differences as an influence on patients’ satisfaction rates in spinal surgery of elderly patients

There is an increased rate of lumbar spinal operations in elderly patients due to lumbar spinal stenosis. Many factors affect the decision of the patient and surgeon to perform the operation, among which are the age of the patient, comorbidities and willingness to undergo surgery. However, the gender of the patient is rarely taken into consideration as a factor for performing the operation. The satisfaction of the patient is an important factor to assess the operative success retrospectively. Therefore, we assessed the differences caused by gender on the satisfaction of elderly patients following lumbar spinal surgery. Three hundred and sixty-seven elderly patients (>65 years) treated in our institution from 1990 to 2000 for lumbar spinal stenosis and who underwent laminectomy without fusion filled in a questionnaire prior to operation regarding their gender, demographic status, comorbidities, activities of daily living (ADL) using the Barthel index, and pain according to visual analogue scale. At follow-up, a telephone interview on 298 patients was structured and included the same pre-operative questions and additional questions regarding the satisfaction rate from surgery.Two hundred and ninety-eight patients responded to our telephone interview with a minimum follow-up of 1 year (mean: 64 months). After surgery, both women and men showed improvement in their ADL, and reduction in pain perception. The number of very satisfied patients was similar in both groups, but women were significantly more dissatisfied with the operation. The surgical parameters, including complications, did not differ between the groups. Gender differences were found to influence the satisfaction rate of lumbar spinal stenosis surgery. Women tend to have less satisfactory results than men. The reasons for that are probably multifactorial and are not related to the surgery per se.     

Comparison of open and minimally invasive techniques for posterior lumbar instrumentation and fusion after open anterior lumbar interbody fusion

Background contextMinimally invasive techniques for spinal fusion have theoretical advantages for the reduction of iatrogenic injury. Although this topic has been investigated previously for posterior-only interbody surgery, such as transforaminal lumbar interbody fusion, similar studies have not evaluated these techniques after anteroposterior spinal fusion, a study design that can more accurately determine the effect of pedicle screw placement and decompression via a minimally invasive technique without the confounding effect of simultaneous interbody cage placement.PurposeTo compare process measures that provide insight into the morbidity of surgery, such as surgical time and the length of postoperative hospital stay between open and minimally invasive anteroposterior lumbar fusion; and to compare the complications during the intraoperative and early postoperative period between open and minimally invasive anteroposterior lumbar fusion.Study designRetrospective case-control study.Patient sampleOne hundred sixty-two patients.Outcome measuresEstimated blood loss, length of surgery, intraoperative fluoroscopy time, length of postoperative hospital stay, malpositioned instrumentation on postoperative imaging, and postoperative complications, including pulmonary embolus and surgical site infection.MethodsPatients who underwent open anterior lumbar interbody fusion followed by either traditional open posterior fusion (Open group) or minimally invasive posterior fusion (minimally invasive surgery [MIS] group) were matched by the number of surgical levels. A chart review was performed to document the intraoperative and postoperative process measures and associated complications in the two groups. Secondary analyses were performed to compare the subgroups of patients, who did and did not undergo a posterior decompression at the time of posterior instrumentation to determine the effect of decompression.ResultsBaseline characteristics were similar between the Open and MIS groups. Estimated blood loss and postoperative transfusion rate were significantly higher in the Open group, differences that the subanalyses suggested were largely because of those patients who underwent concomitant decompression. Length of stay was not significantly different between the groups but was significantly shorter for MIS patients treated without decompression than for Open patients treated without decompression. Intraoperative fluoroscopy time was significantly longer in the MIS group. There was no difference in the infection or complication rates between the groups.ConclusionsOur case-control study comparing patients who underwent anterior lumbar interbody fusion followed by open posterior instrumentation with those who underwent anterior lumbar interbody fusion followed by minimally invasive posterior instrumentation demonstrated that patients undergoing MIS fusion without decompression had less blood loss, less need for transfusion in the perioperative period, and a shorter hospital stay. In contrast, most outcome measures were similar between MIS and Open groups for patients who underwent decompression.     

加压植骨联合单枚Cage的椎体间融合与后外侧融合治疗双节段腰椎椎管狭窄症临床效果的回顾性研究

目的探讨双节段腰椎椎管狭窄症后路减压手术后行椎间加压植骨联合单枚Cage置入的椎体间融合术（posterior lumbar interbody fusion,PLIF）与后外侧融合术（posterolateral fusion,PLF）的临床效果。方法回顾性随访分析53例双节段腰椎椎管狭窄症行后路椎管减压、融合手术的患者,分为2组,PLF组31例,PLIF组22例。对2组患者手术情况进行比较,手术前、后及末次随访进行日本骨科协会（Japanese Orthopaedic Association,JOA）评分及下腰痛的视觉模拟量表（visual analog scale,VAS）评分。结果 2组手术时间差异有统计学意义（P〈0.05）;出血量、输血量差异无统计学意义（P〉0.05）;JOA评分,手术前2组差异无统计学意义（P〉0.05）,术后2组差异有统计学意义（P〈0.05）;术后2组下腰背疼痛的VAS评分差异有统计学意义（P〈0.01）。结论椎弓根螺钉内固定椎间加压植骨联合单枚Cage置入椎体间融合术较后外侧融合效果肯定,手术方式安全,手术后恢复快,出现下腰疼痛病例少,融合率高。