血流动力学不稳定性固定急救技术在椎管狭窄伴退行性腰椎侧凸老年患者中的临床效果

张骏 陈钢

[摘要] 目的 分析血流動力学不稳定性固定急救技术在椎管狭窄伴退行性腰椎侧凸老年患者中的临床效果，为临床治疗提供科学依据。 方法 分析2016年1月至2017年10月于我院骨科就诊接受非融合动态稳定术治疗的56例腰椎管狭窄老年患者的临床资料。结合患者围术期资料，比较术前，术后3、12、24个月及末次随访时不同切面X线检查参数、术后脊椎X线片与MR影像学表现、疼痛评分、日常生活能力评分、镇痛药物使用情况及并发症情况。 结果 所有患者在减压性椎板切除术后，所有减压节段均接受Dynesys系统非融合稳定术，平均住院时间为（6.18±1.85）d。术后3、12、24个月及末次随访时冠状面平衡、矢状面平衡与术前比较，差异有统计学意义（P<0.05）;患者治疗后X线片与MR检查评估结果良好，腰痛、腿痛VAS评分较治疗前明显下降，手术前ODI为（57.72±10.70）%，术后24个月的ODI指标（35.17±6.89）%，差异有统计学意义（P<0.05）。术前使用镇痛药物者28例（100.00%），术后减少至18例（64.29%）;术后15例（53.57%）减少镇痛药用量，3例（10.71%）维持相同剂量。患者并发症发生概率较小，疗效突出。 结论 血流动力学不稳定性固定急救技术能有效改善椎管狭窄伴退行性腰椎侧凸老年患者症状，安全有效，效果突出，能有效改善患者的生活质量。

[关键词] 椎管狭窄;DLS;血流动力学不稳定性固定急救技术;老年人

[Abstract] Objective To analyze the clinical efficacy of hemodynamic instability fixed first aid technology in elderly patients with spinal stenosis and degenerative lumbar scoliosis， and to provide scientific basis for treatment. Methods The clinical data of 56 elderly patients with lumbar spinal stenosis admitted to our hospital treated with non-fusion dynamic stabilization from January 2016 to October 2017 were analyzed. Combined with the perioperative data of patients， the X-ray examination parameters of different sections before operation， 3 months， 12 months and 24 months after operation and the last follow-up， the spine X-ray film and MR imaging performance after operation， the pain score， activity of daily living score， use of analgesics and incidence of complications were compared. Results After decompressive laminectomy of all patients， all decompression segments were treated with Dynesys system non-fusion stabilization， and the average hospitalization time was（6.18±1.85） days. After 3 months， 12 months and 24 months after operation and the last follow-up， the coronal plane balance， sagittal plane balance were significantly different from those before operation， with statistically significant differences（P<0.05）. After treatment， the evaluation results of X-ray film and MR examination were good， and the VAS score of low back pain and leg pain was significantly lower than that before treatment. The ODI before operation was（57.72±10.70）%， and the ODI after 24 months of operation was（35.17±6.89）%， with statistically significant differences（P<0.05）. 28 cases （100.00%） used analgesics before operation， and 18 cases （64.29%） used analgesics after operation; 15 cases（53.57%） reduced the dosage of analgesics after operation， and 3 cases （10.71%） maintained the same dosage. The incidence of complications was small， and the therapeutic efficacy was outstanding. Conclusion Hemodynamic instability fixation first aid technology can effectively improve the symptoms of elderly patients with spinal stenosis and degenerative lumbar scoliosis， which is safe and effective， and can obviously improve the quality of life of patients.

[Key words] Spinal stenosis; DLS; Fixed first aid technique for hemodynamic instability; The elderly

椎管狭窄伴退行性腰椎侧凸（Degenerative lumbar scoliosis，DLS）是一种严重影响脊柱老化的疾病。退行性腰椎侧凸多发生在老年人群中，该病发病率高达68%[1]。此外，在老年疾病中，腰椎椎管狭窄有较高发病率，若与DLS同时存在时会极大地增加手术治疗难度。在手术中，通过减压和固定融合这两种手段可取得一定成效，在一定程度上可矫正症状曲线，减轻病症，因此这两种方式在手术中较为常见。近年来，非融合稳定系统在脊柱退行性疾病的治疗得到广泛运用，其相对之前保守治疗方式优势明显，治疗效果更佳[2]。本研究重点分析DLS患者运用该系统之后的疗效，进一步证明使用该系统能有效维持稳定和防止畸形，现报道如下。……