Elective lumbar spinal decompression in the elderly: is it a high-risk operation?
Elective lumbar spinal decompression in the elderly: is it a high-risk operation?
复制标题
老年人择期腰椎减压术：是高风险手术吗？
DOI：
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发表时间：
2003
期刊：
影响因子：
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通讯作者：
M. Aebi
中科院分区：
文献类型：
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作者：
R. Reindl;T. Steffen;Lara L. Cohen;M. Aebi
介绍
导致椎管狭窄的脊柱退变在老龄化人群中越来越常见。许多病人因为害怕严重的并发症而不接受手术。本研究的目的是将老年患者选择性脊柱减压术的手术风险与全髋关节置换术的风险相关联，全髋关节置换术是一种广为接受的手术，其风险和受益众所周知。
方法
我们回顾了连续68例接受选择性脊柱减压的患者的病历，符合我们的入选标准（年龄65-80岁，无脊柱或髋关节手术，无髋关节骨折，脊柱骨折或马尾综合征，无骨或转移性疾病）。该组与68名随机选择的在同一时期接受全髋关节置换术的患者相匹配。记录两组患者的年龄、性别、美国麻醉医师协会（阿萨）评分、术后早期并发症发生率、手术时间、住院时间和术中出血量。
结果
两组在年龄、性别和阿萨评分方面匹配良好。唯一显著的术中差异是手术时间，脊柱手术需要更长的时间才能完成（191分钟v. 278分钟）。失血量无显著差异。两组有相似数量的威胁生命的并发症（12 v. 14）。脊柱减压组的轻微并发症数量更多（62 v. 125）。
结论
对于因退行性腰椎管狭窄症而疼痛或残疾的老年患者，选择性腰椎减压术是值得的。我们建议明智地使用保守措施，但鼓励转介手术治疗时，这些失败。这种手术，即使需要内固定和植骨，也不会比老年患者的全髋关节置换术更严重或危及生命。
INTRODUCTION
Spinal degeneration leading to spinal stenosis is increasingly common in an aging population. Many patients are not referred for operation because of the fear of severe complications. The purpose of this study was to relate the surgical risks involved in elective spinal decompression in elderly patients to those of total hip arthroplasty, a well-accepted procedure whose risks and benefits are well known.
METHODS
We reviewed the charts of 6 8 consecutive patients who underwent elective spinal decompression and fitted our inclusion criteria (65-80 yr of age, no spinal or hip operations, no hip fractures, spine fractures or cauda equina syndrome and no bone or metastatic disease). This group was matched with a similar group of 68 randomly selected patients who underwent total hip arthroplasty during the same period. We recorded the age, gender, American Society of Anesthesiologists (ASA) score, early postoperative complication rate, operative time, hospital stay and blood lost.
RESULTS
The 2 groups were well matched with respect to age, gender and ASA score. The only significant intraoperative difference was operative time, with the spine procedure taking longer to complete (191 min v. 278 min). Blood loss was not significantly different. Both groups had a similar number of lift-threatening complications (12 v. 14). The number of minor complications was greater in the spinal decompression group (62 v. 125).
CONCLUSIONS
Elective lumbar spinal decompression in elderly patients suffering significant pain or disability due to degenerative lumbar spinal stenosis is worthwhile. We recommend judicious use of conservative measures, but encourage referral for surgical management when these fail. This operation, even when instrumentation and bone grafting are required, is not associated with more serious or life-threatening risks than a total hip replacement in elderly patients.