改良Jaslow技术治疗成人双节段腰椎滑脱症

目的探讨成人双节段峡部裂型腰椎滑脱的手术治疗效果。方法 2006年3月至2010年11月,双节段峡部裂型腰椎滑脱患者30例,实施改良Jaslow技术、椎体间融合术(posterior lumbar interbody fusion PLIF),以日本骨科学会(JOA)下腰痛评分标准、Oswestry功能障碍指数(ODI)、Lenke脊柱植骨融合评价标准、Henderson临床疗效评价标准、椎间隙高度指数、Taillard指数综合评定术后疗效。结果术后30例患者均获得不同程度复位,手术平均复位率(43.60士25.29)%。椎间隙高度指数由术前(17.68±6.67)%,至术后1周(50.99±4.94)%及末次随访(44.37±5.84)%,差异有统计学意义(P<0.01);Taillard指数由术前(20.91±7.11)%,至术后1周(10.23±2.16)%和末次随访(11.87±2.73)%,差异有统计学意义(P<0.01);植骨融合结果:Lenke A级49个节段,B级11个节段;临床JOA评分术前9.60±1.89,至术后6个月22.40±2.06和末次随访22.70±1.63,差异有统计学意义(P<0.01);ODI由术前34.90±5.56,至术后6个月11.80±1.81和末次随访10.70±1.33,差异有统计学意义(P<0.01);临床疗效Henderson评价结果:优19例,良8例,可3例。结论腰后路彻底减压、改良Jaslow技术复位、椎弓根内固定及椎体间融合术治疗成人双节段峡部裂型腰椎滑脱临床疗效满意。

Modified Jaslow technique for treatment of adult double-level isthmic spondylolisthesis

Objective To assess the surgical outcomes of double-level isthmic spondylolisthesis in adults. Methods From Mar.2006 to Nov.2010, 30 patients with double-level lumbar isthmic spondylolisthesis were treated with modified Jaslow technique combined with posterior lumbar interbody fusion. Clinical outcomes were assessed by Japanese Orthopedic Association (JOA) score; the functional disability was quantified by Oswestry Disability Index (ODI); the Lenke grading system was used to assess the spinal fusion; and the Henderson grading system, the intervertebral height index, and the Taillard index were used to assess the clinical outcome. Results All the 30 patients achieved reduction of different degrees, with the mean reduction rate being (43.60±25.29)%. The intervertebral height index was (17.68±6.67)% before operation, increased to (50.99±4.94)% at 1 week after operation and (44.37±5.84)% at the last follow-up. The Taillard index was (20.91±7.11)% before operation, (10.23±2.16)% at 1 week after operation, and (11.87±2.73)% at the last follow-up. The height index and the Taillard index before operation were significantly different from those of the other two time points (1 week after operation and final follow-up, P<0.01). The bone fusion was grade A in 49 levels and grade B in 11 levels. The JOA score increased from 9.60±1.89 before operation to 22.40±2.06 at 6 months after operation and 22.70±1.63 at the final follow-up. ODI was 34.90±5.56 before operation, which was decreased to 11.80±1.81 at 6 months after operation and 10.70±1.33 at the last follow-up. The JOA score and the ODI index before operation were significantly different from those of 6 months after operation and those at the final follow-up (P<0.01). The Henderson clinical outcome was excellent in 19 cases, good in 8 cases, and poor in 3 cases. Conclusion Complete decompression, reduction of isthmic spondylolisthesis by modified Jaslow technique, pedicle screw fixation, and posterior lumbar interbody fusion can achieve satisfactory clinical results for adults with double-level isthmic spondylolisthesis.