摘要
目的分析扩大开窗神经根管减压术治疗老年退行性腰椎管狭窄症(DLSS)的疗效及其影响因素。方法 90例老年DLSS患者根据手术方法不同分为观察组60例、对照组30例,分别行扩大开窗神经根管减压术、常规全椎板切除减压内固定术治疗。比较两组手术情况、腰、腿痛改善程度及疗效,比较观察组痊愈与未痊愈患者临床相关资料差异,并进行Logistic多因素回归分析。结果与对照组相比,观察组手术时间、术后下床时间显著缩短,术中出血量明显减少,手术并发症发生率明显降低,差异有统计学意义(P<0.05),两组术后3个月、2年腰痛、腿痛视觉模拟疼痛评分(VAS)评分均较术前明显降低,但观察组降低幅度明显大于对照组(P<0.05)。观察组临床总有效率为88.33%,显著高于对照组的70.00%(P<0.05),痊愈率为58.33%,略高于对照组的40.00%,但差异无统计学意义(P>0.05)。观察组中,与未痊愈者相比,痊愈者中多节段腰椎管狭窄、合并腰椎滑脱、合并骨质疏松症、术前焦虑或抑郁占比显著增高(P<0.05),上述因素为影响扩大开窗神经根管减压术治疗老年DLSS临床疗效的主要因素(P<0.05)。结论扩大开窗神经根管减压术治疗老年DLSS临床疗效显著,可有效减少并发症,改善腰腿痛,但仍需根据患者是否合并腰椎滑脱、骨质疏松症、焦虑或抑郁等适当调整治疗或干预方案。
Objective To analyze the efficacy and influencing factors of extended fenestration nerve root canal decompression for senile degenerative lumbar spinal stenosis（DLSS）. Methods Ninety elderly DLSS patients were divided into the observation group（n=60） and the control group（n=30） according to the different surgical methods. The two groups were treated with expanded fenestration nerve root canal decompression, and routine laminectomy decompression and internal fixation respectively. The surgery condition, the improvement degree of lumbar and leg pain and efficacy were compared between the two groups, and the clinical related data between the cured patients and the non-cured patients in the observation group were compared, and Logistic regression analysis was made. Results Compared with the control group, the operative time and the postoperative activity time were significantly shorter, and the intraoperative blood loss and incidence rate of surgical complications were significantly lower in the observation group（P〈0.05）. The lumbar and leg pain visual analogue score（VAS） at 3 months and 2 years after operation in the two groups were significantly lower than before treatment（P 0.05）, but the decreasing degree in the observation group was significantly lower than that in the control group（P 0.05）. The total effective rate in the observation group was significantly higher than that in the control group（88.33% vs 70.00%）（P〈0.05）,and the cure rate in the observation group was slightly higher than that in the control group（58.33% vs40.00%）（P 0.05）. The proportion of multi-segment lumbar spinal stenosis, the combined lumbar spondylolisthesis, the combined osteoporosis and the preoperative anxiety or depression were significantly higher in the cured patients than those in the non-cured patients in the observation group（P 0.05）. The multi-segment lumbar spinal stenosis, the combined lumbar spondylolisthesis, the combined osteoporosis and preoperative anxiety or depression were the main factors affected the clinical efficacy of extended fenestration nerve root canal decompression for senile DLSS patients（P〈0.05）. Conclusions Extended fenestration nerve root canal decompression has significant clinical efficacy for elderly DLSS, and can effectively reduce complications and improve lumbar and leg pain,but the therapy or intervention program should be given appropriate adjustment according to whether patients with lumbar spondylolisthesis, osteoporosis, anxiety or depression.
作者
刘万栋
LIU Wan-dong(Department of Emergency,Hospital of Luannan County,Tangshan,Hebei,063500,China)
出处
《颈腰痛杂志》
2018年第3期343-346,共4页
The Journal of Cervicodynia and Lumbodynia
关键词
扩大开窗神经根管减压术
老年
腰椎管狭窄症
疗效
影响因素
extended tenestration nerve root canal decompression
senile
lumbar spinal stenosis
efficacy
influeneing taetors
