成人腰椎滑脱症复位程度对临床疗效的影响

目的通过对Ⅱ、Ⅲ度成人腰椎滑脱症患者手术治疗的回顾性临床研究,探讨腰椎滑脱复位程度对临床疗效的影响。方法 2005年1月至2011年6月,72例成人Ⅱ、Ⅲ度腰椎滑脱症患者接受手术治疗。其中Ⅱ度滑脱52例,Ⅲ度滑脱20例;峡部裂性滑脱症24例,退行性腰椎滑脱症48例;男18例,女54例;年龄39~78岁,平均60.2岁。所有患者均行减压、椎弓根螺钉提拉复位固定、椎间或加横突间植骨融合术。以滑脱复位率作为评价腰椎滑脱复位的程度,分别是完全复位组29例,滑脱复位率100%;部分复位组38例,滑脱复位率82.5%;未复位组5例,滑脱复位率0。分别测出三组的术前滑移程度,术后滑移程度;临床疗效根据患者术前术后及末次随访时的视觉模拟疼痛评分(visual analogue scale,VAS)和日本骨科协会(Japanese orthopaedic association,JOA)功能评分进行评价,组间比较采用单因素方差分析,结果采用SPSS 19.0统计软件进行统计学相关性分析。结果 72例患者术后均获得随访,随访24~66个月,平均38个月。临床疗效评价优50例,良14例,可8例,优良率达88.89%。术后与术前VAS评分,术后及末次随访时JOA评分,术后及末次随访时的滑移程度、腰椎滑脱复位率和临床疗效满意率,未复位组与完全复位组和部分复位组两组差异有统计学意义(P0.01)。而三组间2年融合率差异无统计学意义(P0.05)。结论成人腰椎滑脱症复位程度越完全越有利于患者症状解除和明显改善,未复位组原位融合与完全复位和部分复位组临床疗效差异显著。腰椎滑移程度对远期腰椎融合率无明显影响。

Effects of the Degree of Reduction on the Clinical Outcome in the Surgical Treatment of Adult Lumbar Spondyloisthesis

Objective To evaluate the effect of varying degrees of surgical reduction on the clinical outcome of grade Ⅱ and Ⅲ adult spondylolisthesis patients.Methods From January 2005 to June 2011,72 grade Ⅱ and Ⅲ adult spondylolisthesis patients underwent surgical treatment.In the 72 cases,there were 52 patents of grade Ⅱspondylolisthesis,20 patients of degree Ⅲ spondylolisthesis,24 patents of isthmic spondylolisthesis and 48 patients of degenerative spondylolisthesis.The study included 18 males and 54 females,with age ranging from 39 ～78 years old,with a mean age of 60.2 years old.All patients underwent decompression,pedicle screw fixation,and interbody or intertransverse spinal fusion.Reduction rate was used to evaluate the degree of spondylolisthesis reduction.There were 29 patients in the complete reduction group,achieving spondylolisthesis reduction rate of 100％ ;38 patients were in the partial reduction group,achieving spondylolisthesis reduction rate of 82.5％ ;5 patients were in the non-reduction group,with a spondylolisthesis reduction rate of 0.The degree of slip was recorded for each of the three groups before and after surgery.Clinical outcome was evaluated based on VAS score and JOA score obtained from before operation and after operation,as well as the final follow-up,respectively.Intergroup differences were correlation analyzed using ANOVA and statistical analysis was obtained using the SPSS 19.0 software.Results 72 patients were followed up for 24 to 66 months,with an average of 38 months.Clinical outcome was excellent in 50 cases,good in 14 cases and satisfactory in 8 cases,with excellent rate of 88.89％.Preoperative and postoperative VAS score,postoperative and final followup JOA score,postoperative and final follow-up slip degree,spondylolisthesis reduction rate and clinical outcome,as well as non-reduction group respectively showed significant difference（P ＜ 0.01）compared to complete reduction and partial reduction group.The two-year fusion rate between the three groups showed no significant difference（P ＞ 0.05）.Conclusion As shown in this study,the higher the surgical reduction rate in adult spondylolisthesis patients,the greater the relief of symptoms and efficacy of treatment.The clinical outcome of non-reduction group compared to complete reduction group and partial reduction group showed a significant difference.The degree of slip of the vertebrae had no significant impact on the long-term lumbar fusion rate.