CAJ | 학술논문

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(P<0.01),术后近、中期JOA评分之间差异无统计学意义(P>0.05)。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。
목적：대선택성개창감압수술치료80세이상고령환자다절단요추관협착증적료효진행평개。방법수술채용후정중입로,술전근거환자증상、사체여영상학검사준학정위병조,진행선택성개창감압수술치료；채용JOA평분법평개수술료효。결과우술후근기(6개월내)대환자진행수방,수방환자52명,응답솔100%。우술후중기(24~36개월)대환자진행수방,수방환자47명,응답솔90.4%,평균수방시간30.4개월。 JOA술전평분위(6.93±0.52)분,술후근기JOA평분위(11.98±0.72)분,기중40례(76.9%)체도우,10례(19.2%)체도량,2례(3.9%)체도가,우량비례체도96.1%。술후중기JOA평분(12.06±0.46)분,기중36례(76.6%)체도우,10례(21.3%)량,1례(2.1%)가,우량비례체도97.9%。술후근、중기JOA평분여치료전JOA평분비교,차이구유통계학의의(P<0.01),술후근、중기JOA평분지간차이무통계학의의(P>0.05)。결론선택성개창감압술구유창상소、회복시간단등특점,재LSS고령환병자저일군체중적료효만의,시괄합저일군체적치료방법。
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' 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.