老年重度腰椎管狭窄症围术期特点及其术后早期并发症

摘要

目的：探讨老年重度腰椎管狭窄症围术期特点和术后早期并发症的处理方法。方法回顾性分析我院骨科2008－02至2013－12共184例老年重度腰椎管狭窄症的病历资料，总结术前合并症、术中出血量、手术时间、住院时间，观察术后早期并发症的出现情况，总结处理方法。结果患者平均（68．77±5．76）岁，平均住院时间（27．26±9．61）d，无围术期死亡病例，手术时间平均（3．09±1．09） h，术中出血量平均（618．60±366．50） ml，融合节段超过3个的106例（57．61％）。出现各种并发症合计119例（64．67％），按发生的比例依次排列为切口愈合不良、术后疼痛、全身状况不稳定、低血容量、脑脊液漏、神经根损伤和深静脉血栓形成，对所发生的并发症，均给予了积极有效的对应治疗，效果较好。结论老年重度腰椎管狭窄症患者的手术有一定的风险，但并非不能手术，做好术前准备和术后应对预案，可以提高围术期安全性。%Objective To investigate the peroperative characteristics and early complications in senile people with severe lum -bar spinal canal stenosis .Method From february 2008 to December 2013, a retrospective review of 184 patients with severe lumbar canal stenosis treated surgically with decompressional procedure was performed .Of these, 80 males, 104 females aging from 60~86 years (average of 68.77 ±5.76 years).All patrents underwent surgical decompression .Before operation, all cases consulted with in-ternal medical stuff for the proper treatment of concomitant diseases .The preoperative concomitant diseases , intraoperative bleeding volume, operative and hospitalization time were summarized .The appearance and management of complications at early post-operation stage were observed especially .Result The average hospital stay was 27.26 ±9.61 days.No death cases ocurred during peri-opera-tion.The average operative time was 3.09 ±1.09 h.The average intraoperative blood loss was 618.60 ±366.50 ml.106 cases (57.61%) were noted to have over 3 fusion segments.119 cases (64.67%) were noted to have complications which improved by symptomatic treatment.The complications ranked in the following percentage:poor wound healing, pain, poor body condition, hypov-olemia, cerebrospinal fluid leakage , neuroinjury and deep venous thrombosis . All complications were treated effectively . Conclusions There are definite risks in the operation of senile people with severe lumbar spinal canal stenosis .But in condition of controlling concomitant internal disease , treatment with surgical decompression can still play an important role in neurological recovery and improve safety in peroperative period .