应力滑移率在峡部裂型腰椎滑脱症治疗中应用的中期随访

Clinical Outcomes of Evaluating the Treatment of Spondylolisthesis in Lumbar Spondylolysis by Stress Slippage Rate:A Midterm Follow-up

目的:通过中期有效随访,探讨应力滑移率(Stress Slippage Rate,SSR)在峡部裂型腰椎滑脱症治疗中应用的价值。方法:回顾性分析2008年9月至2014年5月在本院治疗的179例峡部裂型腰椎滑脱症患者,依据SSR的不同程度进行分组,Ⅰ组SSR≥30%,Ⅱ组30%>SSR≥25%,Ⅲ组SSR<25%.应用单因素方差分析三组患者治疗前的JOA(Japanese Orthopaedic Association)评分是否具有统计学差异;应用Pearson相关分析对应力滑移率(SSR)、向前滑移率(ASR)与JOA评分的相关性进行对比,分析影响JOA评分的相关因素;采用Pearson偏相关分析对SSR,ASR与手术复位率(ORR)的相关性进行对比,分析影响术中滑脱椎体复位难易程度的因素;分别对三组患者治疗前后JOA评分、SSR值改变行t检验,评价差异是否具有统计学意义。结果:三组患者治疗前的JOA评分差异具有统计学意义(F=6.441,P=0.028),行两两之间LSD发现各组间JOA评分差异均具有统计学意义(P<0.01)。ASR,SSR与治疗前JOA评分具有负相关性,其中ASR(r=-0.219,P=0.017),SSR(r=-0.534,P<0.01)。ORR与SRR呈明显的正相关(r=0.697,P=0.01),差异有统计学意义,而ORR与ASR之间不具有相关性(r=-0.024,P=0.872)。Ⅰ组、Ⅲ组治疗前后JOA评分差异均有统计学意义(P<0.01),Ⅱ组差异无统计学意义(P=0.71)。Ⅰ组、Ⅲ组治疗前后SSR值差异均有统计学意义(P<0.01),Ⅱ组差异无统计学意义(P=0.11)。结论:应力滑移率(SSR)不但是评价峡部裂型腰椎滑脱症椎间稳定性的一项有效指标,而且对于不同程度患者的治疗方案的选择以及术中及术后复位效果的评估都具有重要的指导意义。

Objective：The goal of the study was to evaluate midterm clinical results of using stress slippage rate（SSR）in the treatment of spondylolisthesis in lumbar spondylolysis.Methods：We identified 179 patients at an average follow-up of 35.4months from September 2008 to May 2014.According to the stress slippage rate,all patients were divided into 3groups：group I（SSR≥30%）,group Ⅱ（30%SSR≥25%）and group Ⅲ（SSR25%）.JOA（Japanese Orthopedic Association）scores of three groups were compared using one-way analysis of variance before treatment.The correlations between SSR and JOA score,ASR（anterior slippage rate）and JOA score were analyzed by Pearson correlation analysis.The correlations between SSR and ORR（operative reduction rate）,ASR and ORR were analyzed by Pearson correlation analysis.According to the above results,we analyzed influential factors of the reduction of spondylolisthesis.JOA scores and SSRs were compared before and post treatment in each group by t-test.Results：There were statistically significant differences among the JOA scores of patients in the three groups before treatment（F=6.441,P=0.028）.There were also statistically significant difference between each pair of JOA scores（P0.01）before treatment.ASR was negatively correlated with the JOA score before treatment（r=-0.219,P=0.017）,as well as between SSR and JOA score（r=-0.534,P0.01）.There was significant positive correlation of ORR and SRR（r=0.697,P=0.01）,however,there was no correlation between ASR and ORR（r=-0.024,P=0.872）.There were statistically significant differences of JOA scores in group I and Ⅲbefore and post treatment（P〈0.01）,as well as SSR（P〈0.01）.There were no significant differences of JOA scores and SSR in groupⅡ before and post treatment（P=0.71,P=0.11）.Conclusions：Stress slippage rate could be used as an evaluation indicator for intervertebral stability of spondylolisthesis in lumbar spondylolysis before and post treatment.Longterm follow-up is necessary to define the optimal application of SSR.