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1、·394·JournalofPraetieaIOrthopaedicsVo1.20,No.5,May.2014文章編號(hào):1008—5572(2014)05-0394—05同期手術(shù)治療頸腰椎椎管狹窄癥吳康,李浩曦,胡朝暉,謝湘濤,梁博偉(廣西科技大學(xué)附屬柳州I市人民醫(yī)院脊柱外科,廣西柳州545001)摘要:目的評(píng)價(jià)同期手術(shù)治療頸椎、腰椎管狹窄癥的療效及安全性。方法2005年3月至2012年5月,納入頸椎、腰椎管狹窄癥患者6l例,同一患者均采用兩批脊柱外科醫(yī)師分別行同時(shí)聯(lián)合手術(shù)。依據(jù)日本骨科協(xié)會(huì)(Jap
2、aneseorthopaedicassociation,JOA)評(píng)分系統(tǒng)、Oswestry功能障礙指數(shù)(oswestrydisabilityindex,ODI)、Nuriek評(píng)分、患者滿意指數(shù)、JOA改善率及并發(fā)癥等進(jìn)行療效測(cè)評(píng)。結(jié)果隨訪12個(gè)月,平均JOA提高4.2分,平均ODI改善39.4,平均Nurick分級(jí)改善1.16級(jí),平均患者滿意度為(2.53±0.87)分,平均JOA康復(fù)率為(47.36-4-25.85)%。在小于6O歲的患者中,ODI(P=0.03)及Nuriek分級(jí)(P=0.04)
3、顯著改善。結(jié)論同期手術(shù)治療并存的頸椎、腰椎椎管狹窄癥是可行的,年齡、術(shù)中失血及手術(shù)時(shí)間可能與手術(shù)效果及并發(fā)癥相關(guān)。不建議年齡大于等于60歲患者采用同時(shí)聯(lián)合手術(shù)。關(guān)鍵詞:頸椎;腰椎;椎管狹窄癥;手術(shù)治療中圖分類號(hào):R681.57文獻(xiàn)標(biāo)識(shí)碼:BASingle-stageSurgeryofCoexistingLumbarandCervicalStenosisWUKang,LIHao—xi,HUChao—hui,etal(DepartmentofSpineSurgery,LiuzhouPeopleSHosp
4、ital,GuangxiUniversityofScienceandTechnology,Liuzhou545001,China)Abstract:ObjectiveToevaluatethetreatmentofasingle—stagesuregeryofcoexistinglumbarandcervicalstenosisandrelaIivefactors.MethodsFromMarch2005toMay2012.61caseswithcoexistinglumbarandcervical
5、stenosisreceivedasingle—stagesurgerybytwoteams.ResultswereevaluatedwithmodifiedJapaneseOrthopedicAssociationscore(JOA),oswe—strydisabilityindex(ODI),Nurickgrade(NG),patientsatisfactionindex,JOArecoveryrate,bloodlossandcomplication.ResultsTheJOA,ODIandN
6、Gshowedanaverageimprovementof4.2,39.4,1.16pointsat12months,respectively.Patientsatisfactionindexwas(2.53±0.87).TheaverageJOArecoveryratewas(47.364-25.85)%.Intheagegroupbelow60,theimprovementwasstatisticallyhigherintermsofODI(P:0.03)andNG(P=0.04).Conclu
7、sionAsingle—stagesuregerymaybeefectiveandsaftinthetreatmentofcoexistinglumbarandcervicalstenosis.Age,bloodlossanddurationofsurgeryde—cidethecomplicationrateandoutcomeofsurgery.However,thistypeofsurgeryisnotrecommendedinpatientsabovetheage0f60years.Keyw
8、ords:cervicalvertebrae;lumbarvertebrae;spinalstenosis;surgicaltreatment頸椎管合并腰椎管狹窄臨床表現(xiàn)復(fù)雜,多同時(shí)存在上運(yùn)程≤1年為39.3%,1—5年為58.9%,>15年為14.8%。術(shù)動(dòng)神經(jīng)元和下運(yùn)動(dòng)神經(jīng)元損傷的表現(xiàn),互相干擾,易導(dǎo)致誤前合并其他疾病29例,頸椎全椎板切除術(shù)50例,椎板成形診漏診。該病在治療上,尤其是二期手術(shù)頸、腰椎先后部位術(shù)11例,腰椎全椎板切除術(shù)41例,腰椎管擴(kuò)大成形術(shù)4例,