| Objective:1.To investigate the pathogenesis of the patients with Degenerative Spondylolisthesis from the two aspects of the sagittal balance and function of trunk muscles.2. restoring the sagittal positional balance through operation, improving the function of trunk muscles through Chinese medicine and functional exercises, to observe the outcome of therapy of integrating traditional Chinese and western medicine, which is PLIF (posterior lumbar interbody fusion)with internal fixation, cooperating with Chinese medicine and functional exercises.Method:1. Two groups were set up: the normal group and the patient group. The former was consisted of twenty persons without lumbago and the latter thirty patients with Degenerative Spondylolisthesis. (1)sagittal parameters were measured in both groups, including sacral slope (SS) , lumbar lordosis(LL), pelvic incidence (PI) and the percent of slipping (PS). Then, t-check was adopted to compare and analyse each parameter of the two groups; and correlation of each parameter in two groups was analysed with Pearson coefficient of correlation. (2)The function of trunk muscles was measured in both groups, including the highest, lowest and average temperature of the interested area with infrared photography, muscle strenth of the trunk muscles with manual muscle testing (MMT) method, and endurance of trunk muscles with B-S method. Then, t-check was adopted to compare and analyse each parameter of the two groups; and correlation of each parameter in two groups was analysed with Pearson coefficient of correlation.2. Therapy of integrating traditional Chinese and western medicine, which is PLIF(posterior lumbar interbody fusion) with internal fixation, cooperating with Chinese medicine and functional exercises, was applied to thirty-six patients with Degenerative Spondylolisthesis. Post - operational X-ray evaluation was performed with slip angle,percent of slip, reduction rate , disc index and fusion rate, the clinical outcome were evaluated with JOA score and Oswestry Disability Index (ODI).Results:1. (1)The PI, SS, and LL in the normal group were52.0±10.5°,41.5±8.8°,34.5±7.2°respectively, while60. 8±18.3°,57.7±13.4°,39. 8±8.4°repectively in the patient group, which were higher than those in normal group. There are statistical significance in the difference (P<0.05). (2)PI is significantly correlated with SS, LL and PS(P<0.05). SS is significantly correlated with LL and PS (P<0. 05). (3) The highest, lowest, and average temperature of the interested area in infrared thermography of normal group were33.4±0.8℃,31.4 + 0.5℃,32.3±0. 7℃respectively, while are35.1±0. 7℃,31.1 + 0.6℃,33. 4±0. 6℃of patient group. The highest and average temperature of patient group were higher than those of the normal group. There were significance in the difference (P<0.05). The lowest temperature in patient group was lower than that of the normal grbup; However, the difference was without significance(P>0. 05). (4) In normal group, the muscle strenth of trunk extending muscles was为4. 95±0. 22 grade, and that of abdominal muscles 4. 90±0. 31grade; while in patient group, the muscle strenth of trunk extending muscles was4.13±0.78grade, and that of abdominal muscles was 4.03±0.76 grade. The difference was significant in comparison(P<0. 05). (5) In normal group, the endurance of trunk extending muscles is89.13±19.68 seconds, and that of abdominal muscles is 50.55±8.31seconds; while in patient group, the endurance of trunk extending muscles was46. 57±9. 08 seconds, and that of abdominal muscles was 35.43±6.93 seconds. The difference was significant in comparison (P<0. 05). (6)There was no significant correlation between muscle strenth with infrared photography parameters (P > 0.05). Neither was there between endurance of muscles and the lowest temperature in infrared photography (P >0. 05). But the endurance of muscles was significnatly correlated with the highest and average temperature in infrared photography (P<0. 05).2. On average, patients were followed up for 16.8 months . (1) The Slip angles were8. 4±0. 9°before operation, 3.5±0.7after operation and 3.6±0.6°at follow-up. The percent of slip were23. 2±4. 9% before operation, 1.3±2.2 after operation, and 1.7±2.8% at follow-up. The disc index were 19.7±3.8% before operation, 31.1±3.9% after operation, and30.0±5.2% at follow-up. These three parameters were significantly different with themselves before and after operation (P<0. 05 ) and there were no significant difference in the three between after-operation and follow-up (P>0. 05) . The reduction rate was 94.3±0.1% after operation and92.7±0.1% at follow-up and there was no signif icant difference (P>0. 05) . (2)Bony fusion were observed in all cases without complications of internal fixation failure. (3) JOA score were increased from 12. 2±3. 3 before operation to25. 3±3.3 after operation, 24.9±2.9was remainded at follow up. ODI were decreased from 45.3±4.7%before operation tol9. 9±3. 5% after operation, 21.6±6.6% was remainded at follow up. both of JOA score and ODI were significantly different before and after operation (P<0. 05 ), but there were no significant difference between post operation and follow-up (P>0. 05) .Conclusion:1. Changes of sagittal parameters and the function of the trunk muscles had significant importance with Degenerative Spondylolisthesis, which could be one of pathogenesis of the patients with Degenerative Spondylolisthesis.2. Restoring the sagittal positional balance through operation, improving the microcirculation of the lumbar-back part through Chinese medicine, increasing muscle strenth and endurance of the trunk muscles through functional exercises, therapy of integrating traditional Chinese and western medicine, which is Posterior Lumbar Interbody Fusion with internal fixation, cooperating with Chinese medicine and functional exercises is the effective technique in the treatment of Degenerative Spondylolisthesis. |
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