改良Jaslow技术治疗腰椎管狭窄症23例疗效观察

Clinical observations of modified Jaslow technology in the treatment of 23 patients with lumbar stenosis

目的 探讨对改良Jaslow技术进行改进后治疗腰椎管狭窄症的临床疗效。方法 回顾性分析2011年8月—2012年4月手术治疗的23例腰椎管狭窄症患者的临床资料。对改良Jaslow技术进行改进，采用半椎板切除、经椎间孔椎体间融合以及椎弓根内固定术治疗腰椎管狭窄症，观察患者术前、术后疼痛视觉模拟评分法（VAS）评分、日本矫形外科协会（JOA）评分、Oswestry功能障碍指数（ODI）的变化，采用JOA评分改善率进行临床疗效评估。结果 23例患者均顺利完成手术。术后患者并发脑脊液漏1例，予相应处理后痊愈，无逆行颅内感染发生。23例均获随访，随访时间12—23个月，平均18个月。所有患者症状、体征均显著改善，无断钉及内固定松动、移位。末次随访时与术前相比，VAS评分、ODI均明显降低，JOA评分明显增高，差异均有统计学意义（P值均〈0．01）；复查中立位侧位X线检查提示：腰椎间隙均达到骨性融合。术后1年按JOA评分改善率评定疗效，优21例、良2例，优良率100％。结论 腰椎管狭窄症手术方式多样，需要根据患者术前评估结果选择手术方案。对改良Jaslow技术进行改进，采用腰后路半椎板切除、经椎间孔椎体间融合以及椎弓根内固定术治疗腰椎管狭窄症临床疗效满意。

Objective To explore the clinical curative effects of improved modified Jaslow technology on treatment of lumbar stenosis. Methods The retrospective analysis was used in 23 lumbar stenosis patients who had surgical treatment from August 2011 to April 2012. Semi-laminectomy, transforaminal lumbar interbody fusion （TLIF） and transpedicular screw fixation were used with improved modified Jaslow technology to treat the patients. Preoperative and postoperative visual analogue scale （VAS） scores, Japanese Orthopaedic Association （JOA） scores and Oswestry disability index （ODI） were observed. Improvement rate of JOA was adopted for evaluation on clinical curative effects. Results Twenty- three cases were successfully completed the surgery. One case of patient was accompanied with cerebrospinal fluid leakage after the surgery. The patient was given the corresponding treatment and then recovered, and no retrograde intracranial infection occurred. Twenty-three cases were followed up with 12 to 23 months （average 18 months）. The symptoms and signs in all patients were significantly improved. No screw was broken, and no internal fixation was loosened and shifted. VAS scores and ODI were significantly reduced at the last follow-up compared with the preoperative values, while JOA scores were obviously increased, and the differences were statistical significance （ all P values 〈 0.01 ）. Review with X ray examination at neutral position and lateral position suggested that all of the lumbar intervertebral space reached bony fusion. The curative effect was evaluated according to the recovery rate of JOA scores at I year after the surgery. There were 21 cases of excellent results and 2 cases of good results, with the excellent and good rate of 100%. Conclusions There are various surgical methods for the treatment of lumbar stenosis. The operation scheme should be selected based on the patients＇ preoperative evaluation results. Semi-laminectomy, TLIF and transpedicular screw fixation were used with improved modified Jaslow technology to treat the patients with lumbar spinal stenosis, and the clinical curative effects were satisfied.