| IntroductionDegenerative lumbar spondylolisthesis is also named lumbar notho-slippage, which is one of the three lumbar degenerative deseases. Posterior Lumbar Interbody Fusion (PLIF ) is always the operation with high fusion rate for treating degenerative lumbar spondylolisthesis, but bone block's collapse and dislocation,nerve injury,complication of cutting flank bone,intervertebral space's narrowing and pseudoarticulation formation are the existing problems of PLIF. Vamvanij discovered that the fusion rate of degenerative lumbar spondylolisthesis was 76 percents. Even though the operation methods have a great improvement recent years, but 13.2 percents internal fixations needed overhauling remainly. Pristine bony fusion should be the main goal of operation.The propotional evaluation criterion is necessary for measuring the effect of orthopedics operations. It has been the indispensable ingredient for scientific research to judge the validity of therapeutic tool with clinical effect evaluation criterion. Orthopedists' recognition about therapeutic effect evaluation system has become deeper and deeper, more and more clinicians and scientific researchers begin to think it's highly of the science,utility,repeatability,comparison of evaluation criterion, but the study about it is junior in my country now.Materials and Methods 一,Materials1,JOA Lower Back Pain Scoring System: JOA(Japanese Orthopedics Association) Lower Back Pain Scoring System is mainly used to value the postoperative therapeutic effect of lumbar deseases, which was applicated since 1975. Now it is already translated many editions and used throughout the world. Now the measuring scale assimilated by the Chinese that being applicated in my country was translated directly from Japanese edition, which is divided into four items- subjective symptoms,clinical objective sign,daily activities and Bladder function. We can calculate the therapeutics improvement rate through cumulating the preoperative and post-operation score. The measuring scale contain not only subjective reception but also clinical objective check-up of patients, which is more overall than simple subjective evaluation.2,Patients: The patients who have been operated in my hospital (2003,4～2005,2)with lumbar spinal stenosis and degenerative lumbar slippage was divided into two sets randomly. A group was treated with interbody fully compression fusion operation, which was consisted of 23 patients(female 18, male 5) who's ages were from 37 to 78(mean, 58.1). B group was treated with ususl PLIF operation, which was consisted of 19 patients(female 13, male 6) who's ages were from 35 to 76 (average age-57.2). Preoperative X-ray examation indicated that there was a shift over 3mm in I-B for all the patients, Meyerding categorization was in I°～II°,there was spinal stenosis in CT and different nerve compression in MRI.二,Methods1,Operation methods:A group was treated with interbody fully compression fusion operation. Laminectomy and bilateral partial facetectomies were performed in slippage levels in A group to free the nerve roots, followed by intervertebral foraminal enlargement and distraction through inserted pedicle screws. Intervertebral disc including upper and low endplate were removed with rongeur,and morselized cancellous bone were fuldfilled into cavity. Reduction and interbody compression fusion were achieved through enough compression on the segmental pedicle screw system to make contact the posterior wall of adjacent vertebrae.B group was applied for usual whole laminectomy and brace fixed with pecidle screw. By post-way median incision, the lateral mass of vertebraes of illness and inferior vertebraes are implanted four pedicle screws. The vertebral plate and partial articular process of vertebraes are ectomized. Windowing is applied in intervertebral space, the nucleus gelatinosus is ectomized as far as possible, morselized cancellous bone were fuldfilled into cavity. Reduction were achieved through brace on the segmental pedicle screw system.2,Evaluation methods:To take lumbar lateral position X-rays at one week,three months,six months,twelve months,eighteen months after operation for evaluating the stability of interbody fully compression fusion and height change of I-B . To take lateral position of excessive extend and flexion X-rays to observe bone graft fusion at twelve months and eighteen months after operation.All the patients with lumbar degenerative spondylolisthesis were investigated with JOA Low Back Pain Scoring System and Oswestry Disability Index before operation; Two investigations were done after operation(follow-up time was all over 12 months). The first time after operation, two measuring scales were used; The second time, the patients were investigated with only JOA scale. JOA and ODI score of every patient was calculated.3,Statistical methods:The statistics data was calculated with SPSS 10.0 software. To calculate the difference of two groups' JOA score before operation with t test; Two groups' postoperative fineness rate was compared through x~2 test; To analysis the difference of two groups' JOA and ODI score after operation with x~2 test by the first follow-up score; The repeated JOA score of two groups was analysised by Pearson coefficient correlation respectively; the test level (P) double side 0.05.Experimental result23 intervertebral spaces were fused in A group, the X-rays measurement of postoperation indicated that 5 vertebral bodys' hinder margin was touched,15 vertebral bodys' hinder margin was small than 3mm and 3 was small than 5mm. There was no change in the height of I-B that was fused in one week to six months after operation, the bone graft was not absorbed. The bone graft turned vague and it's limit was not clear with bone plate under cartilage in one week to six months after operation. The lateral position of excessive extend and flexion X-rays in 12～18 months after operation showed that all the bone graft was fused.19 intervertebral spaces were fused in B group and were fllowed up for 20～28 months, pseudoarticulation formation was observed in 5 cases and legs deep vein thrombogenesis in 2. The bone graft was fused in 14 patients.There was no significant difference in JOA score of A and B group before operation. The postoperative fineness rate of A group that was achieved by post-operation first time JOA score was 95.65%, B group was 63.16%, x~2=5.17, P<0.05, there was significant difference in A and B group; 95.65% post-operation fineness rate was achieved in A group by post-operation first time JOA score, 86.96% was gained by ODI score, x~2=2.86, P>0.05, there was no difference in JOA and ODI score; B group'fineness rate after post-operation' first time follow-up was 63.16% by JOA score and was 68.42% by ODI score, there was no difference. Pearson coefficient correlation was 0.926 and 0.918 in A and B group respectively, indicating significant correlation. The postoperative fineness rate was no significant difference in ODI and JOA score, indicating higher validity and reaction sensitivity.ConclusionInterbody enough compression fusion by pedicle screws with intervertebral foraminal enlargement operation is a new type and effective method in the management of degenerative lumbar spondylolisthesis, which can achieve early stabilization,interbody bony fusion and higher clinical improvement rate than PLIF; The JOA Low Back Pain Scoring Systerm in Chinese shows the superior reliability,validity,sensitivity. |
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