应力滑移率对腰椎峡部裂并滑脱症的诊疗价值

The diagnostic and therapeutic value of stress slippage rate on lumbar isthmic spondylolisthesis

目的探讨应力滑移率（stress slippage rate，SSR）在腰椎峡部裂并滑脱症诊断和治疗中的价值，并与目前常用的疗效评价标准进行比较。方法分析132例腰椎峡部裂并滑脱症患者的SSR、向前滑移率（anterior slippage rate，ASR）与JOA下腰痛诊疗标准评分的相关性及80例手术者的SSR、ASR与手术复位率的相关性。按照张恩忠等SSR标准，将132例患者分为手术组、观察组与保守组，分析三组JOA评分改善率差异。对52例非手术治疗者进行平均24个月动态观察计算ASR的改善率，并进行统计学分析。结果SSR、ASR与治疗前JOA评分间均具负相关性（r=-0．62，P〈0．01；r=-0．22，P〈0．05）；80例手术者SSR与手术复位率间具正相关性（r=0．71，P〈0．05）；而ASR与手术复位率间不具相关性（P〉0．05）；对52例观察组及保守组经24个月动态观察，两组ASR改变差异有统计学意义（t=2．57，P=0．011）。三组间治疗前JOA评分差异有统计学意义（F=6．56，P=0．03）；三组间治疗后JOA评分改善率，手术组与保守组间差异无统计学意义（P=0．56），手术组、保守组与观察组间差异均有统计学意义（P值分别为0．000，0．010）。结论SSR不仅可以作为腰椎峡部裂并滑脱症椎间稳定性的量化指标，而且对腰椎峡部裂并滑脱症的诊断、治疗方法选择、手术复位程度及预后评估具有重要指导作用。

Objective To approach the diagnostic and therapeutic value of stress slippage rate （SSR） on lumbar isthmic spondylolisthesis. Methods To analyze correlation of SSR, anterior slippage rate （ASR） and pretherapeutic JOA scores （PJOAS） for 132 patients with lumbar isthmic spondylolisthesis, and the correlation of SSR, ASR and operative reduction rate （ORR） for 80 cases treated by operation. All patients were divided into three groups as the operative group, the wait-and-see group and the conservative group according to the standard which introduced by Zhang. The differences of improvement rate （IP） between each group were analyzed. The ASR changes of 52 patients with non-operative treatment were observed. Results Negative correlation were found between PJOAS and SSR （r=-0.62, P〈0.01）, and between PJOAS and ASR （r=-0.22, P〈0.05） in all patients. Positive correlation were found between SSR and ORR （r=-0.71, P〈0.05）, but correlation of ASR and ORR were not statistically significant （P〉0.05） in the operative group. The changes of ASR between the wait-and-see group and the conservative group were statistically significant （t=2.57, P=-0.011） in average 24-month follow-up. The differences of three groups in PJOAS were significant（F=6.56, P=-0.03）. The IP of post-treatment JOA scores between the operative group or the conser- vative group and the wait-and-see group had significant difference （P=0.000, 0.010）; however, there were no difference between the operative group and the conservative group （P=0.56）. Conclusion SSR is not only quantitative index that measured the stability of lumbar isthmic spondylolisthesis, but also could provide the therapeutic evidence and evaluation of the prognosis.