CAJ | 학술논문

目的：：探讨老年退变性腰椎管狭窄症( degenerative lumbar spinal stenosis,DLSS)的个体化手术治疗方案选择、经验和临床疗效。方法：回顾性分析2010年9月至2014年2月收治的92例老年腰椎管狭窄症患者的临床资料,除外合并椎弓峡部裂的真性腰椎滑脱症患者。老年退变性腰椎管狭窄症患者按个体化方案接受了手术治疗,其中男性40例,女性52例,年龄65~84岁,平均年龄70.3岁。根据入院完善检查后患者的身体状态及耐受手术的能力,骨质条件,脊柱退变程度,狭窄部位、原因及类型,为患者设计个体化的手术方案。所有患者均行后路开放手术,包括单侧椎板开窗减压(包括必要时的潜行中央区及对侧减压)26例,扩大中央开窗及神经根管扩大减压43例,后路椎板切除减压加椎间植骨融合内固定23例。其中单节段椎管狭窄53例,双节段狭窄24,三节段及以上15例。根据术前、术后腰椎改良JOA评分系统(29分)进行手术效果的评价。结果：92例患者获得4~41个月的随访,平均随访时间18.6个月。无死亡病例,无瘫痪病例,短期症状加重但均在2~6周不等时间内明显恢复3例,术后发生脑血管并发症1例,感染2例,脑脊液漏4例。按上述手术方式顺序,平均改善率分别为78.4%、81.3%、80.6%,手术效果优24例,良59例,可9例,优良率90.2%。结论：老年退变性椎管狭窄症患者由于病情复杂,根据临床表现及影像学资料,确定责任节段及致病因素,有针对性地个体化选择手术方案,可获得良好的疗效。是否进行间盘切除及是否辅以内固定或行融合手术,须谨慎选择。
목적：：탐토노년퇴변성요추관협착증( degenerative lumbar spinal stenosis,DLSS)적개체화수술치료방안선택、경험화림상료효。방법：회고성분석2010년9월지2014년2월수치적92례노년요추관협착증환자적림상자료,제외합병추궁협부렬적진성요추활탈증환자。노년퇴변성요추관협착증환자안개체화방안접수료수술치료,기중남성40례,녀성52례,년령65~84세,평균년령70.3세。근거입원완선검사후환자적신체상태급내수수술적능력,골질조건,척주퇴변정도,협착부위、원인급류형,위환자설계개체화적수술방안。소유환자균행후로개방수술,포괄단측추판개창감압(포괄필요시적잠행중앙구급대측감압)26례,확대중앙개창급신경근관확대감압43례,후로추판절제감압가추간식골융합내고정23례。기중단절단추관협착53례,쌍절단협착24,삼절단급이상15례。근거술전、술후요추개량JOA평분계통(29분)진행수술효과적평개。결과：92례환자획득4~41개월적수방,평균수방시간18.6개월。무사망병례,무탄탄병례,단기증상가중단균재2~6주불등시간내명현회복3례,술후발생뇌혈관병발증1례,감염2례,뇌척액루4례。안상술수술방식순서,평균개선솔분별위78.4%、81.3%、80.6%,수술효과우24례,량59례,가9례,우량솔90.2%。결론：노년퇴변성추관협착증환자유우병정복잡,근거림상표현급영상학자료,학정책임절단급치병인소,유침대성지개체화선택수술방안,가획득량호적료효。시부진행간반절제급시부보이내고정혹행융합수술,수근신선택。
Objective:To discuss the selection, experience and clinical curative effect of individual operation for degenerative lumbar spinal stenosis ( DLSS ) in aged people. Methods: A retrospective analysis was made on clinical data of 92 patients with DLSS from September 2010 to February 2014 who were treated with individual operation exclude those who suffered from lumbar isthmic spondylolisthesis. The average age was 70. 3 years old ( range from 65-84 years old ) , including 40 males and 52 females. All the patients were performed posterior approach operation with individual strategy according to the difference of physical condition, bone condition and the type of stenosis. In those people, 26 cases underwent hemilaminectomy ( including submersible decompression if necessary) , 43 cases underwent central laminectomy with decompression of lumbar root canal and 23 cases underwent total laminectomy combined with lumbar interbody fusion and internal fixation and internal fixation. According to the modified Japanese Orthopaedic Association Scores ( JOA) of lumbar diseases,the outcome of the preoperation and postoperation were evaluated. Results:92 cases were followed up for 4-41 months, the average follow up period was 18. 6 months. No dead case, no paralytic case, one cerebrovascular complication, two infection and 4 cerebrospinal fluid leakage occur. The mean postoperative improvement rate was 78. 4%, 81. 3%and 80. 6%, respectively. 24 cases were excellent, 59 cases were good and 9 cases were fair. Conclusion:Degenerative lumbar spinal stenosis in aged is complex, individual operation strategy according to the difference of physical condition, bone condition and the type of stenosis is necessary and the outcome of operation relatively good. Discectomy and fusion combined internal fixtion should be used reasonably.