改良Jaslow技术下单枚Z-cage联合单侧椎弓根螺钉固定治疗腰椎间盘突出症

Single Z-cage interbody fusion and unilateral pedicle screw fixation by modified Jaslow technique for lumbar disc herniation

[目的]探讨改良Jaslow技术下单枚Z-cage联合单侧椎弓根螺钉固定治疗腰椎间盘突出症的疗效。[方法]回顾性分析本科2012年4月~2014年9月采用改良Jaslow技术下单枚Z-cage联合单侧椎弓根螺钉固定治疗40例腰椎间盘突出症患者资料。记录手术时间、术中出血量、切口长度、住院时间。并对手术前后的视觉模拟评分(VAS)、Oswestr功能障碍指数(ODI)和日本矫形外科协会(JOA)评分进行比较。[结果]40例患者均顺利完成手术,手术时间平均(80.26±1.48)min;术中出血量平均(115.33±1.42)ml;切口长度平均(6.31±0.55)cm;住院时间平均(10.16±0.62)d;随访时间平均(26.42±1.62)个月,VAS和ODI评分随时间延长而显著减少,差异有统计学意义(P<0.05),而JOA评分随时间延长而显著增加,差异有统计学意义(P<0.05)。与术前相比,术后1个月时椎间隙高度显著增加,差异均有统计学意义(P<0.05);但术后1个月至末次随访时椎间隙高度无明显变化(P>0.05)。末次随访时,所有患者腰痛、下肢放散痛症状消失,生活质量均明显改善。腰椎影像检查显示所有患者椎体间植骨均获骨性融合,无1例发生椎弓根螺钉松动、断钉及椎间Cage移位、沉降情况。[结论]改良Jaslow技术下单枚Z-cage联合单侧椎弓根螺钉固定治疗腰椎间盘突出症是安全、可行、有效的手术方式。

[Objective] To explore the outcomes of single Z- cage interbody fusion and unilateral pedicle screw fixation by modified Jaslow technique for lumbar disc herniation. [Methods] A retrospective study was conducted on 40 patients who received surgical treatment with single Z- cage interbody fusion and unilateral pedicle screw fixation by modified Jaslow technique for lumbar disc herniation in our department from April 2012 to September 2014. The surgical operation time, bleeding, length of incision, and hospital stay were recorded, additionally visual analogue scale （VAS） score, Oswestry disability index （ODI） and Japanese Orthopaedic Association （JOA） score were compared before and after operation. [Results] All the 40 patients had operation performed smoothly with operation time of （80.26 ± 1.48） mins on average, intraoperative blood loss of （115.33± 1.42） ml, incision length of （6.31 ±0.55） cm and hospital stay of （10.16±0.62） days. The patients were followed up for an average of （26.42 ±1.62） months. Both VAS and ODI significantly decreased as time elapsed with statistical differences （P〈 0.05）, conversely the JOA scores statistically increased over time （P〈 0.05）. Compared to that before operation, the intervertebral space height considerably increased at 1 month postoperatively （P〈0.05） , however, the height kept unchanged from 1 month after operation to the latest follow up （P〉0.05）. At the latest follow up, all patients had substantial improvement in quality of life without lower back pain and radical lower extremity pain. Radiographic images revealed bony fusion achieved in all patients with no implant loosening, displacement and fracture noted in anyone of them. [Conclusion] The modified Jaslow technique with single Z- cage interbody fusion and unilateral pedicle screw fixation is a safe, feasible and effective surgical intervention for lumbar disc herniation.