经改良的Jaslow技术治疗峡部裂型滑脱4年随访结果分析  

Analysis of results on minimum 4 year follow up of modified posterior lumbar interbody fusion for the treatment of isthmic spondylolisthesis

作　　者：袁健东[1] 王靖[1] 周海波[1] 傅强[2] 陈志明[2] 赵杰[2] 

机构地区：[1]温州医学院附属第一医院骨科,浙江温州325000 [2]第二军医大学附属长海医院骨科

出　　处：《中国骨伤》2010年第7期519-522,共4页China Journal of Orthopaedics and Traumatology

摘　　要：目的:采用经改良的Jaslow技术治疗峡部裂型腰椎滑脱症,评价其远期疗效。方法:自2000年4月至2002年1月,75例峡部裂型滑脱患者(MeyerdingⅠ度24例,Ⅱ度35例,Ⅲ度16例),其中男35例,女40例,年龄23～71岁,平均40岁,临床症状主要为间歇性跛行、下腰痛和放射痛。采用改良的Jaslow技术辅助症状侧单枚椎间融合器进行手术。通过测量手术前后的滑脱率、腰椎前凸角、椎间隙高度比、植骨融合率观察影像学情况,通过视觉模拟量表(VAS)、Oswestry残疾指数(ODI)和侯树勋标准评价疼痛程度及社会和生活功能情况。结果:75例均获随访,时间48～62个月,平均50.2个月。滑脱率从术前35.6%降至术后9.7%(矫正72.8%),腰椎前凸角由术前(53.6±15.7)°减少至末次随访(51.2±17.1)°,椎间隙高度由术前(58.6±12.3)%升至末次随访(91.5±11.2)%,末次随访植骨融合率为97.3%(73/75)。VAS、ODI分别由术前(6.2±2.5)分、(47.8±10.3)%减轻至末次随访的(2.5±1.9)分、(10.3±3.0)%。经过比较,除腰椎前凸角外其他项目均有统计学意义。根据侯树勋评价标准:优53例,良12例,可8例,差2例,优良率86.7%。并发症:内固定失败2例,一过性神经功能障碍3例,假关节形成3例。结论:经改良的Jaslow技术适合治疗MeyerdingⅠ-Ⅲ度的峡部裂型滑脱,长期随访结果表明该技术减压充分、固定可靠、临床效果满意。Objective：To investigate the long term results of modified Jaslow technique to treat isthmic spondylolisthesis.Methods：From April 2000 to January 2002,75 patients with isthmic spondylolisthesis（Meyerding gradeⅠhad 24 cases,grade Ⅱ had 35,grade Ⅲ had 16）were treated with a modified Jaslow technique using one single fusion cage on the symptomatic side.There were 35 males and 40 females with an average age of 40 years old,ranging from 23 to 71 years.Clinical symptoms included intermittent claudication,radicular pain and low back pain.Pre and postoperative percentage slip,lumbar lordosis,height ratio of intervertebral space and the fusion ratio were analyzed according to radiographic conditions;Visual Analogue Pain Score（VAS）,Oswestry Disability Index（ODI）,Houshuxun criterion were applied to assess the pain and the conventional functions.Results：All patients were followed up from 48 to 62 months with an average of 50.2 months.The percentage slip reduced from 35.6% preoperative to 9.7% at the last follow up（corrected 72.8%）,lumbar lordosis from（53.6±15.7）° to（51.2± 17.1）° and the height ratio increased from（58.6±12.3）% to（91.5±11.2）%,the rate of fusion was 97.3%（73 /75）at the last follow up.The mean VAS and ODI before operation was（6.2±2.5） scores and（47.8±10.3）%,respectively,decreased to（2.5± 1.9） scores and（10.3±3.0）% at the last follow up.There was statistical significance in all items except for lumbar lordosis.According to Houshuxun criterion,the results was excellent in 53 cases,good in 12,fair in 8 and poor in 2,the rate of excellent and good was 86.7%.Complication included 2 case internal fixation failure,3 cases transient neurologic deficits and 3 cases pseudoarticulation formation.Conclusion：The modified Jaslow technique is suitable for isthmic spondylolisthesis（Meyerding Ⅰ-Ⅲ）,which has advantage of sufficient decompression,solid fixation and can obtain satisfactory clinical results with long term follow up.

关 键 词：脊椎滑脱 脊柱融合术 外科手术 随访研究 

分 类 号：R681.5[医药卫生—骨科学]