摘要
目的探讨高龄腰椎管狭窄症患者接受腰椎后路减压+Bacfuse棘突间撑开固定术的疗效及安全性。方法回顾性分析2015年4月至2016年1月接受腰椎后路减压+Bacfuse固定融合的70岁以上腰椎管狭窄症患者17例,记录患者一般情况、内科合并症、手术时间、出血量、围术期并发症等,并记录术前术后腰椎JOA评分,行配对t检验。术后3个月复查X线判断腰椎稳定性,并记录内固定有无移位松动表现。结果本组17例中,男8例,女9例,年龄平均(77.59±4.27)岁。其中14例内科合并症数量在两项以上,平均手术时间(84.41±22.07)min,平均出血量(94.71±88.33)ml。所有患者均行腰椎椎板开窗减压,部分患者切除了椎间盘及下关节突。17例患者共使用Bacfuse固定28个节段。术中3例患者发生了棘突骨折,1例硬膜撕裂,1例发生术后伤口感染。腰椎JOA评分术前平均(14.71±3.04)分,术后3个月随访平均为(24.59±1.42)分,差异有统计学意义(t=12.16,P=0.00)。除1例患者疗效欠佳外,其余患者均满意。术后3个月复查X线示无明显腰椎不稳定、或内固定松动、断裂、移位等。结论高龄腰椎管狭窄症患者,积极处理内科合并症,大都可以耐受手术。Bacfuse作为一种新型的棘突间撑开器,可以应用于高龄腰椎管狭窄症患者的手术治疗中,在患者适应症选择合适的前提下可以取得良好的临床疗效。
Objective The purpose of this study was to clarify the safety and clinical outcomes of the lumbar decompression and Bacfuse（as a new interspinous process devices, IPD） implantation treating for lumbar spinal stenosis（LSS） in elderly patients. Methods We retrospectively reviewed 17 elderly patients with LSS who had underwent lumbar decompression and Bacfuse implantation between April 2015 and January 2016. The clinical deta of patients including the age, comorbidities, operative time and bleeding, pre- and post- operation Japanese Orthopaedic Association（JOA） scores and postoperative complications were recorded. Radiographic evaluations included anteroposterior, lateral and flexion/extension lateral lumbar x-rays at the three-months postoperative follow-up to observe the lumbar and implant stabilities. Results Seventeen elderly patients included 8 male and 9 female aged 70-86 years old（average 77.59±4.27 years old）, with more than 2 comorbidities mostly. The average operative time was 84.41±22.07 min and the average bleeding volume was94.71 ± 88.33 ml. Because there were multilevel cases, totally 28 Bacfuses were implanted. The spinous process fracture was observed in 3 cases, who underwent more than 2-levels Bacfuse implantation. Other complications included dural tear in one patient and surgical site infection in another. The average of pre-operation JOA score was 14.71±3.04, and post-operation JOA score was 24.59±1.42, which were significantly different（t = 12.16, P = 0.000.05）. Except one patient, all other patients satisfied with the therapy. Operative segment instability or implant failure was not found by the X-ray at the final follow-up. Conclusion This study has demonstrated that decompression with Bacfuse implanted is a reasonable and effective operation for elderly LSS patients, if appropriate patients are selected and their comorbidities are properly treated.
出处
《北京医学》
CAS
2016年第7期643-647,共5页
Beijing Medical Journal
