摘要
目的了解伴发各种全身性疾病的高龄脊髓型颈椎病患者手术治疗的可能性并分析手术疗效。方法自 1993年 1月～ 1998年 10月共治疗 70岁以上 (70～ 84岁，平均 72.3岁 )的脊髓型颈椎病患者 43例，其中有全身性伴发疾病者 26例，部分患者存在一种以上伴发疾病，包括糖尿病 4例、冠心病 6例、高血压病 12例、心律失常 12例、脑血管疾患 4例。 43例中 5例施行前路椎间盘切除植骨融合术， 38例行颈椎后路椎管扩大成形术。结果手术后发生心律失常 2例、应激性溃疡 1例、糖尿病酮症酸中毒 1例、硬膜外血肿 2例、伤口延迟愈合 1例、脑脊液漏 2例。 43例术前 JOA评分 2～ 13分，平均 6.7分；术后 2周 JOA评分 6～ 16分，平均 11分，平均改善率 42.8％。 29例患者术后随访 6～ 60个月，平均 24.6个月， JOA评分 7～ 17分，平均改善率 65.2％；疗效优 11例 (38％ )、良 11例 (38％ )、可 6例 (20.6％ )、差 1例 (3.4％ )。结论对高龄脊髓型颈椎病患者，术前只要认真处理伴发疾病及并发症，一般均能平稳度过围手术期，并取得良好的手术效果。
Objective To investigate perioperative clinical features and results of surgical treatment of cervical spondylotic myelopathy (CSM) in aged patients (≥ 70 years). Methods From January 1993 to October 1998, 43 patients with CSM undergone surgery were reviewed. The average age at the time of surgery was 72.3 years (ranged from 70 to 84 years). Twenty- six patients had associated conditions, i.e. diabetes mellitus in 4, coronary heart disease in 6, hypertension in 12, arrhythmia in 12, cerebral vascular disease in 4. Laminoplasty in 38 patients and anterior decompression in 5 patients were performed. Results After operation there were arrhythmia in 2 patients, stress ulcer in 1, acidosis ketosis in one case of diabetes mellitus, epidural hematoma in 2, delayed healing in 1, leakage of cerebrospinal fluid in 2. The preoperative JOA score ranged from 2 to 13 points, with an average of 6.7. Twenty- nine patients were followed up for 6－ 60 months, with a mean period of 24.6 months, JOA score ranged from 7 to 17 points, and in average the recovery rate was 65.2％ ;11 of 29 were excellent, 11 good, 6 fair, 1 poor. Conclusion If the associated disorders and complications in aged patients with CSM are properly handled, the perioperative period will be safe. Surgical decompression for CSM appears to be a beneficial procedure even for the aged patients.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2001年第1期27-29,共3页
Chinese Journal of Orthopaedics
关键词
脊柱融合术
椎板切除术
老年人
脊髓型颈椎病
Cervical vertebrae
Spinal cord compression
Spinal fusion
Laminectomy
Aged
