两种术式治疗轻度退行性腰椎滑脱的疗效比较

Comparison effect of two surgical methods for treatment of mild degenerative lumbar spondylolisthesis

目的比较改良Jaslow技术经椎间孔入路腰椎椎间融合术(TLIF)和传统TLIF治疗轻度退行性腰椎滑脱(DLS)的疗效。方法将95例轻度DLS患者按术式不同分为传统TLIF组(采用传统TLIF治疗,49例)和改良Jaslow组(采用改良Jaslow技术TLIF治疗,46例)。比较两组手术指标、影像学指标,采用疼痛VAS评分、JOA评分及ODI评分评价临床疗效。结果患者均获得随访,时间12~46(21.13±11.80)个月。(1)切口长度、术中出血量、手术时间两组比较差异均无统计学意义(P>0.05)。(2)滑脱度:两组术后1年均低于术前(P<0.01)。腰椎前凸角:两组术后1年比较差异无统计学意义(P>0.05)。椎间隙高度:两组术后1年均高于术前(P<0.01);术后1年改良Jaslow组高于传统TLIF组(P<0.01)。末次随访时椎间融合器沉降值、椎间融合器沉降率:改良Jaslow组均少(低)于传统TLIF组(P<0.05),手术节段均骨性融合。(3)疼痛VAS评分、JOA评分及ODI评分:末次随访时两组均优于术前(P<0.01);两组比较差异均无统计学意义(P>0.05)。结论与传统TLIF相比,改良Jaslow技术TLIF治疗轻度DLS可以更有效地维持椎间隙高度,同时能延缓椎间融合器的沉降,临床疗效满意。

Objective To compare the efficacy of transforaminal lumbar intervertebral fusion(TLIF)with improved Jaslow technique and traditional TLIF for treatment of mild degenerative lumbar spondylolisthesis(DLS).Methods The 95 patients with mild DLS were divided into traditional TLIF group(49 cases treated with traditional TLIF)and improved Jaslow group(46 cases treated with improved Jaslow technique TLIF),according to different surgical procedures.The surgical and imaging indicators were compared between two groups.Clinical efficacy was evaluated using pain VAS,JOA score,and ODI score.Results All patients were followed up for 12~46(21.13±11.80)months.①There was no statistically significant difference in incision length,intraoperative bleeding volume,and surgical time between the two groups(P>0.05).②Spondylolisthesis degree:after 1 year of surgery,it was lower in both groups than before surgery(P<0.01).Lumbar lordosis angle:there was no statistical difference between the two groups at 1 year after surgery(P>0.05).The intervertebral space height:at postoperative 1 year,both groups were both higher than the preoperation(P<0.01),and the modified Jaslow group was higher than the traditional TLIF group(P<0.01).The settlement value and settlement rate of intervertebral fusion cage:at the last follow-up,the improved Jaslow group was less(lower)than the traditional TLIF group(P<0.05),and all surgical segments had bony fusion.③Pain VAS,JOA score and ODI score:at the last follow-up,the data of two groups were all better than before surgery(P<0.01);there was no statistically significant difference between the two groups(P>0.05).Conclusions Compared with traditional TLIF,the improved Jaslow technique TLIF can more effectively maintain the height of the intervertebral space and delay the settlement of the intervertebral fusion cage for treatment of mild DLS.The clinical efficacy is satisfactory.