改良Jaslow法与传统经椎间孔椎间融合术治疗单节段腰椎管狭窄症的对比研究

Comparative study of modified Jaslow technique and traditional transforaminal lumbar interbody fusion in the treatment of single-level lumbar spinal stenosis

背景:改良Jaslow法已应用于腰椎管狭窄症(LSS)的治疗,临床效果良好,但目前尚无改良Jaslow法与传统经椎间孔椎间融合术(TLIF)临床疗效对比的相关研究。目的:探讨改良Jaslow法治疗单节段LSS的应用效果,并与传统TLIF进行对比研究。方法:回顾性分析2016年1月至2017年7月行手术治疗的65例单节段LSS患者,其中改良Jaslow组35例,男11例,女24例,年龄41~71岁,平均(54.2±9.3)岁;传统TLIF组30例,男10例,女20例,年龄44~80岁,平均(52.6±9.6)岁。所有患者随访18~30个月,平均(25.2±4.2)个月。对比两组患者的年龄、性别、体重指数(BMI)、手术时间、术中出血量、并发症等临床资料;采用术前、术后1周及末次随访的腰痛和腿痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、SF-36调查问卷评估临床疗效;比较椎间隙高度(IH)、腰椎前凸角(LL)、融合节段的前凸角(SL)、椎间融合器下沉值(CS)、椎间融合器沉降率(SR)等影像学参数。结果:两组患者的性别、年龄、手术时间、出血量比较,差异无统计学意义(P>0.05)。两组术后1周及末次随访的腰痛VAS、腿痛VAS、ODI较术前均有明显改善(P<0.05),但两组间差异无统计学意义(P>0.05)。两组末次随访的SF-36较术前均有明显改善(P<0.05),但两组间差异无统计学意义(P>0.05)。两组术后1周及末次随访的LL、SL与术前比较,差异均无统计学意义(P>0.05),两组间差异亦无统计学意义(P>0.05)。两组术后1周及末次随访的IH较术前均明显升高(P<0.05)。改良Jaslow组术后1周及末次随访的IH均高于传统TLIF组(P<0.05)。改良Jaslow组的CS和SR为(0.8±0.5)mm和5.7%,低于传统TLIF组的(1.2±1.0)mm和26.7%(P<0.05)。末次随访时,两组患者的手术节段均获得骨性融合。结论:与传统TLIF相比,改良Jaslow法治疗单节段LSS并不增加手术时间和出血量,且在恢复IH、降低CS和SR上具有优势。

Background:The modified Jaslow method has been applied to the treatment of lumbar spinal stenosis,and the clini?cal effect is good.However,there is no comparison between the modified Jaslow method and the transforminal lumbar interbody fusion(TLIF)in clinical efficacy.Objective:To investigate the effect of modified Jaslow technique on single-level lumbar spinal stenosis through comparison with traditional TLIF.Methods:Data of 65 patients with single-level lumbar spinal stenosis who underwent surgery from January 2016 to July 2017 in our hospital,including 35 patients receiving modified Jaslow technique(11 males,24 females)with the mean age of(54.2±9.3)years(range,41-71 years old)and 30 patients receiving traditional TLIF(10 males,20 females)with the mean age of(52.6±9.6)years(range,44-80 years old)were retrospectively analyzed.All patients were followed up for 18-30 months with the mean of(25.2±4.2)months.The demographic data,body mass index(BMI),operation time,intraoperative blood loss,complications and other clinical data were recorded.The visual analogue scales(VAS)of low back pain and leg pain,Oswestry disability index(ODI),and 36-item short-form health survey(SF-36)were used for evaluation;the imaging parameters such as intervertebral space height(IH),lumbar lordosis(LL),segmental lordosis(SL),cage subsidence(CS)and subsidence rate of interbody fusion cage(SR)were recorded before the operation,one week after the operation and the fi?nal follow up.Results:There was no significant difference in demographic data,operation time and blood loss between the two groups(P>0.05).The VAS scores of low back pain and leg pain and ODI were significantly improved at one week after the opera?tion and final follow up compared with that before operation(P<0.05)and SF-36 was improved at the final follow up than that before the operation in both groups(P<0.05),and there was no significant difference between the two groups(P>0.05).No differ?ence was found in LL and SL at one week after the operation and final follow up compared with that before the operation(P>0.05),and there were no significant difference between the two groups(P>0.05).The IH was significantly higher at one week after the operation and at the final follow-up than before the operation(P<0.05),and the IH at one week after the operation and final fol?low up were higher in the modified Jaslow group than in the traditional TLIF group(P<0.05).The CS of the modified Jaslow group was significantly lower than that of the traditional TLIF group[(0.8±0.5)mm vs.(1.2±1.0)mm,P<0.05].The SR of the tra?ditional TLIF group was significantly higher than that of the modified Jaslow group(26.7%vs 5.7%,P<0.05).Solid fusion was achieved in all the patients at the final follow-up.Conclusions:Compared with the traditional TLIF,the modified Jaslow tech?nique does not increase the operation time and intraoperative blood loss in the treatment of single-level lumbar spinal stenosis,and it has the advantages of restoring the intervertebral space height and reducing CS and SR.