复位导向器在强直性脊柱炎胸腰椎后凸畸形截骨矫形术中的应用

Application of the novel reduction technique in pedicle subtraction osteotomy for thoracolumbar kyphosis secondary to ankylosing spondylitis

中文关键词:  强直性脊柱炎  后凸  经椎弓根椎体截骨  脱位  复位技术

英文关键词:Ankylosing spondylitis  Kyphosis  Osteotomy  Subluxation  Reduction technique

中文摘要:

  【摘要】 目的：探讨经椎弓根椎体截骨（pedicle subtraction osteotomy，PSO）治疗强直性脊柱炎（ankylosing spondylitis，AS）胸腰椎后凸畸形术中采用复位导向器预防截骨椎脱位的有效性。方法：回顾性分析2014年4～12月在我院行单节段PSO矫形内固定术中应用复位导向器的27例AS胸腰椎后凸畸形患者。所有患者手术前后均摄站立位全脊柱正侧位X线片并在矢状面上测量胸椎后凸角（thoracic kyphosis，TK）、全脊柱最大后凸Cobb角（global kyphosis，GK）、腰椎前凸角（lumbar lordosis，LL）和矢状面平衡距离（sagittal vertical axis，SVA）。随访观察神经并发症及截骨椎脱位情况，以截骨水平的头侧与尾侧脊椎间，截骨椎在矢状面上移位（sagittal translation，ST）大于5mm定义为截骨椎脱位。结果：所有患者均顺利完成手术。平均随访5.2±2.4个月（3～12个月），术前TK为43.2°±10.6°，GK为72.6°±15.1°，LL为2.3°±13.5°，SVA为12.8±4.2cm；术后分别为42.9°±11.8°、38.2°±12.4°、-38.6°±13.0°和3.2±5.8cm；末次随访时分别为42.7°±10.5°、38.8°±15.2°、-38.4°±11.6°和3.3±6.4cm。除TK外，其余参数手术前后相比均有统计学意义（P<0.01）；末次随访时，TK、GK、LL及SVA的矫正丢失无统计学差异（P>0.05）。无患者出现术中截骨椎脱位，除1例短暂性右下肢麻木外，无其他神经并发症发生。结论：采用PSO治疗强直性脊柱炎胸腰椎后凸畸形患者，术中应用复位导向器械能有效预防截骨椎脱位的发生。

英文摘要:

  【Abstract】 Objectives: To investigate the effectiveness of the novel reducer for preventing intra-operative vertebral subluxation in ankylosing spondylitis(AS) patients undergoing pedicle subtraction osteotomy(PSO) for thoracolumbar kyphosis. Methods: A total of 27 AS patients with thoracolumbar kyphosis undegoing PSO between April 2014 and December 2014 was retrospectively reviewed. The thoracic kyphosis(TK), global kyphosis(GK), lumbar lordosis(LL) and sagittal imbalance(SVA) were measured. The subluxation of osteotomized vertebra was defined as the sagittal displacement of more than 5mm between the cranial and caudal vertebrae at the osteotomized level. Results: All patients underwent surgery successfully. All patients were followed up for 5.2±2.4 months(3-12 months). The preoperative TK was 43.2°±10.6°, GK was 72.6°±15.1°, LL was 2.3°±13.5°, SVA was 12.8±4.2cm respectively. The postoperative data were 42.9°±11.8°, 38.2°±12.4°, -38.6°±13.0° and 3.2±5.8cm respectively. The final follow-up data were 42.7°±10.5°, 38.8°±15.2°, -38.4°±11.6° and 3.3±6.4cm respectively。Significant differences were observed in terms of the improvement of GK, LL and SVA(P<0.01). With respect to the mean loss of correction of TK, GK, LL and SVA, no differences were noted(P>0.05). Moreover, no intra-operative vertebral subluxation was observed, except for one transient numbness of the right lower extremity, no other neurological deficit was occurred. Conclusions: The novel reduction technique can effectively prevent intra-operative vertebral subluxation in AS patients undergoing PSO for thoracolumbar kyphosis.