双椎体截骨术矫正强直性脊柱炎重度胸腰椎后凸畸形

Two-level pedicle subtraction osteotomy for correction of severe thoracolumbar kyphosis due to ankylosing spondylitis

中文关键词:  强直性脊柱炎  后凸畸形  经椎弓根椎体截骨术  矢状面平衡

英文关键词:Ankylosing spondylitis  Kyphosis deformity  Pedicle subtraction osteotomy  Sagittal balance

中文摘要:

  【摘要】 目的：观察双椎体经椎弓根楔形截骨矫正强直性脊柱炎重度胸腰椎后凸畸形的治疗效果。方法：2009年5月～2010年12月我院采用双椎体经椎弓根楔形截骨、椎弓根螺钉内固定术治疗强直性脊柱炎重度胸腰椎后凸畸形患者18例，均为男性，年龄19～47岁，平均34.8岁。术前全脊柱最大后凸Cobb角70°~108°（82.6°±17.5°），顶椎均位于胸腰段；胸椎后凸角46°~67°（55.2°±15.3°），胸腰段后凸角25°~43°（32.4°±12.6°），腰椎前凸角-37°~-11°（-19.5°±10.3°）；站立位颌眉角43°～130°（67.2°±21.9°）；侧位X线片上C7铅垂线距S1后上角的距离为11～35cm（18.3±14.8cm）。采用Bridwell-Dewald脊柱疾患疼痛及功能评定标准进行手术前后疗效评价。结果：手术时间为5.3±1.0h（3.7～6.9h），术中出血量1887.5±850.9ml（600～3000ml）。术中硬膜破裂4例，术后伤口表浅感染1例，一侧下肢神经症状1例，经治疗后均恢复良好。随访24～48个月，平均33.5个月。术后1周时测量，全脊柱最大后凸Cobb角矫正到21.3°±4.2°，颌眉角改善到9.3°±12.8°，C7铅垂线距S1后上角的距离改善到3.0±4.7cm；术后1周全脊柱最大后凸Cobb角、胸椎后凸角、胸腰段后凸角、腰椎前凸角、颌眉角和C7铅垂线距S1后上角距离均较术前明显改善（P<0.05）。末次随访时，上述指标与术后1周比较差异无统计学意义（P>0.05）；X线片显示所有患者内固定位置良好。患者能平视行走，末次随访时疼痛、工作限制情况及社交限制情况较术前明显改善（P<0.05）。结论：对强直性脊柱炎严重胸腰椎后凸畸形患者，应用双椎体经椎弓根楔形截骨术治疗是一种安全、有效的方法，可较好地恢复脊柱矢状位生理曲度。

英文摘要:

  【Abstract】 Objectives: To analyze the clinical results of two-level pedicle subtraction osteotomy for correction of severe thoracolumbar kyphosis due to ankylosing spondylitis. Methods: From May 2009 to December 2010, 18 males with ankylosing spondylitis complicated with severe thoracolumbar kyphosis underwent two-level pedicle subtraction osteotomy, the average age at admission was 34.8 years(range, 19-47 years). Preoperative global kyphosis(GK) Cobb angle was 70°-108°(82.6°±17.5°) and the apex vertebra was at thoracolumbar region. Preoperative thoracic kyphosis(TK), thoracolumbar kyphosis(TLK) and lumbar lordosis(LL) angle was 46°-67°(55.2°±15.3°), 25°-43°(32.4°±12.6°) and (-37°)-(-11°)[(-19.5°)±10.3°], respectively. Preoperative chin-brow vertical angle at standing position was 43°-130°(67.2°±21.9°). Global sagittal imbalance was determined by C7 plumb line and its relationship with the posterior superior corner of the sacrum, and the preoperative one was 11-35cm(18.3±14.8cm). Bridwell-Dewald scale was used to evaluate the clinical outcomes. Results: The average operation time was 5.3±1.0h(3.7-6.9h), and the average blood loss was 1887.5±850.9ml(600-3000ml). Dura matter tearing was noted in 4 cases and skin infection in 1 case, 1 case developed transient neurologic deficits, but all healed after proper intervention. The average follow-up time was 33.5 months(24-48 months). The postoperative mean GK angle, chin-brow vertical angle, global sagittal imbalance was corrected to 21.3°±4.2°, 9.3°±12.8° and 3.0±4.7cm, respectively. The postoperative GK, TK, TLK, LL, chin-brow vertical angle and global sagittal imbalance improved significantly compared with the preoperative data(P<0.05), there was no significant difference between postoperation and final follow-up(P>0.05). Instrument displacement was not noted at final follow-up. All patients could walk with normal vision. Satisfactory clinical outcomes including changes of pain, social and working status were noted at final follow-up(P<0.05). Conclusions: Two-level pedicle subtraction osteotomy is a safe and effective surgical treatment for severe thoracolumbar kyphosis due to ankylosing spondylitis kyphosis, which can promote physiological sagittal spinal curvature.