CAJ | 학술논문

目的探讨改良Jaslow技术治疗退行性脊柱侧凸的临床疗效.方法回顾性分析2011年3月-2012年6月徐州医学院附属医院骨科手术治疗的14例退行性脊柱侧凸患者的临床资料.患者均实施改良Jaslow技术、椎间孔椎体间融合术以及椎弓根内固定术,以日本矫形外科协会(JOA)下腰痛评分标准、Oswestry功能障碍指数(ODI)以及Cobb角的变化综合评定术后疗效.结果 14例患者均顺利完成手术.术后并发脑脊液漏1例,予相应处理后痊愈,无逆行颅内感染发生.所有患者均获随访12～ 16个月,平均14个月,术后症状、体征得到改善.末次随访Cobb角(3.35°±0.87°)和ODI(10.53 ±2.00)均较术前(20.37°±5.57°,39.42±8.34)明显降低(t=10.99,t=15.06,P值均＜0.01),JOA评分为(25.00±1.22)分较术前(11.42±2.40)分明显增高(t=-24.72,P＜0.01).术后1年,按JOA评分改善率评定疗效:优13例,良1例.复查患者腰椎X线正侧位片,均无内固定松动、移位及断钉;中立位侧位X线检查显示腰椎间隙均达到骨性融合.结论退行性脊柱侧凸手术方式多样,需要根据患者术前检查结果选择手术方案.采用腰后路彻底减压、改良Jaslow技术复位、椎弓根内固定及椎间孔椎体间融合术治疗脊柱侧凸临床疗效满意.
목적 탐토개량Jaslow기술치료퇴행성척주측철적림상료효.방법 회고성분석2011년3월-2012년6월서주의학원부속의원골과수술치료적14례퇴행성척주측철환자적림상자료.환자균실시개량Jaslow기술、추간공추체간융합술이급추궁근내고정술,이일본교형외과협회(JOA)하요통평분표준、Oswestry공능장애지수(ODI)이급Cobb각적변화종합평정술후료효.결과 14례환자균순리완성수술.술후병발뇌척액루1례,여상응처리후전유,무역행로내감염발생.소유환자균획수방12～ 16개월,평균14개월,술후증상、체정득도개선.말차수방Cobb각(3.35°±0.87°)화ODI(10.53 ±2.00)균교술전(20.37°±5.57°,39.42±8.34)명현강저(t=10.99,t=15.06,P치균＜0.01),JOA평분위(25.00±1.22)분교술전(11.42±2.40)분명현증고(t=-24.72,P＜0.01).술후1년,안JOA평분개선솔평정료효:우13례,량1례.복사환자요추X선정측위편,균무내고정송동、이위급단정;중립위측위X선검사현시요추간극균체도골성융합.결론 퇴행성척주측철수술방식다양,수요근거환자술전검사결과선택수술방안.채용요후로철저감압、개량Jaslow기술복위、추궁근내고정급추간공추체간융합술치료척주측철림상료효만의.
Objective To explore the clinical curative effects of modified Jaslow technology on treatment of degenerative scoliosis.Methods A retrospective analysis was conducted on 14 patients with degenerative scoliosis underwent surgeries in the affiliated hospital of Xuzhou Medical College from March 2011 to June 2012.They received modified Jaslow technology,transforaminal interbody fusion and pedicle-screw internal fixation.The postoperative efficacy was evaluated by Japanese Orthopaedic Association (JOA) score for lower back pain,Oswestry disability index (ODI) and Cobb angle.Results These patients underwent successful surgeries.One patient with postoperative cerebrospinal fluid leakage received corresponding treatment and healed without retrograde intracranial infection.All patients were followed up for 12 to 16 months,with an average of 14 months.All patients were significantly improved in postoperative symptoms and signs.The last follow-up Cobb angle (3.35° ±0.87°) and ODI(10.53 ± 2.00) were significantly decreased compared with those before surgery(20.37° ± 5.57°,39.42 ± 8.34,t =10.99,t =15.06,all P values ＜0.01),and JOA score was significantly increased compared with that before surgery (25.00 ± 1.22 vs 11.42 ± 2.40,t =-24.72,P ＜ 0.01).After surgery for one year,the efficacy was evaluated according to the improvement rate of JOA score,and there were 13 patients with excellent efficacy and one patient with good efficacy.The anterioposterior and lateral X-ray lumbar radiographs were reviewed,without loosening,displacement and screw breakage in internal fixation.Review with X-ray test at neutral position and lateral position suggested that the all of the lumbar intervertebral space reached bony fusion.Conclusions Due to diverse ways of degenerative scoliosis surgery,the surgical plan needs to be selected depending to preoperative examination results.The posterior lumbar complete decompression,reset by modified Jaslow technology,pedicle-screw internal fixation and transforaminal interbody fusion have satisfactory clinical efficacy in treatment of scoliosis.