老年多节段腰椎管狭窄症改良椎管扩大成形术△（开放获取）

Improved enlarging laminoplasty for multi-level lumbar spinal stenosis in elderly

摘要:

[目的] 探讨改良腰椎管扩大成形术治疗老年多节段腰椎管狭窄症（lumbar spinal stenosis, LSS） 的临床疗效。[方法] 回顾性分析本院2020 年2 月—2022 年12 月行改良腰椎管扩大成形术治疗的35 例老年多节段LSS 患者的临床资料，评价临床及影像资料。[结果] 所有患者均顺利完成手术，无严重并发症。平均随访（23.9±9.2） 个月，与术前相比，术后3 个月及末次随访时腰痛VAS 评分[(4.8±1.3), (1.5±0.7), (1.4±0.5), P＜0.001]、腿痛VAS 评分[(6.9±1.1), (2.5±0.7), (2.3±0.6), P＜0.001] 及ODI评分[(90.0±20.0), (10.0±10.0), (10.0±10.0), P＜0.001] 均显著降低，平地连续行走距离[(183.7±114.4) m, (817.1±108.4) m, 1 212.9±175.5) m, P＜0.001] 显著增加。影像方面，与术前相比，术后3 个月及末次随访时椎管面积[(1.3±0.1) cm2, (1.8±0.1) cm2, (1.8±0.1) cm2,P＜0.001] 及侧隐窝矢状径[(3.0±0.5) mm, (5.4±0.6) mm, (5.5±0.6) mm, P＜0.001] 均显著增加。[结论] 改良腰椎管扩大成形术治疗老年多节段LSS 临床疗效满意，是一种安全可行的治疗方法。

Abstract:

[Objective] To investigate the clinical efficacy of the modified enlarging laminoplasty for multi-level lumbar spinal stenosis( LSS) in elderly. [Methods] A retrospective study was conducted on 35 elderly patients who received the modified enlarging laminoplastyfor multi-level LSS in our hospital from February 2020 to December 2022. The clinical and imaging data were evaluated. [Results] All pa-tients were successfully operated on without serious complications, and were followed up for a mean of (23.9±9.2) months.With time preop-eratively, 3 months postoperatively and the last follow-up, the low back pain VAS score [(4.8±1.3), (1.5±0.7), (1.4±0.5), P＜0.001], leg painVAS score [(6.9±1.1), (2.5±0.7), (2.3±0.6), P＜0.001] and ODI scores [(90.0±20.0), (10.0±10.0), (10.0±10.0), P＜0.001] were significantly de-clined, whereas the continuous walking distance on flat land [(183.7±114.4) m, (817.1±108.4) m, (1 212.9±175.5) m, P＜0.001] significantlyincreased. As for imaging, spinal canal area [(1.3±0.1) cm2, (1.8±0.1) cm2, (1.8±0.1) cm2, P＜0.001) and sagittal diameter of lateral recess[(3.0±0.5) mm, (5.4±0.6) mm, (5.5±0.6) mm, P＜0.001] were significantly increased over time. [Conclusion] This modified enlarging lamino-plasty is a safe and feasible method for the treatment of multi-level LSS in elderly and achieves satisfactory clinical consequence.