强直性脊柱炎后凸畸形患者经椎弓根椎体截骨术后心功能变化

Cardiac function changes in patients with ankylosing spondylitis kyphosis after pedicle subtraction osteotomy

中文关键词:  强直性脊柱炎后凸畸形  心功能  静息心率  经椎弓根椎体截骨术

英文关键词:Ankylosing spondylitis kyphosis  Cardiac function  Resting heart rate  Pedicle subtraction osteotomy

中文摘要:

  【摘要】 目的：观察强直性脊柱炎（ankylosing spondylitis，AS）后凸畸形患者应用经椎弓根椎体截骨术（pedicle subtraction osteotomy，PSO）治疗后心功能的变化。方法：2011年10月~2013年10月共有36例行PSO的AS患者纳入本研究，男31例，女5例；年龄21~50岁（39±10岁）；病程5~27年（17±6年），术前后凸Cobb角45.5°~108.8°（63.8°±22.4°）。术前和术后1年时评测患者静息心率、活动能力评分（active capacity score，ACS），并行超声心动图检查，测量指标包括左心室射血分数（left ventricular ejection fraction，LVEF）、左心室缩短分数（left ventricular fraction shortening，LVFS）、左心室舒张早期血流峰值速度（E峰）、舒张中晚期血流峰值速度（A峰）、E/A比值、E峰减速时间（deceleration time，DT）、等容舒张时间（isovolumetric relaxation time，IVRT），根据美国和欧洲超声学会指南评估患者左心室舒张功能。结果：随访至术后1年，共有32例完成了随访，失访率为11.1%。术后后凸Cobb角5.1°~34.5°（18.1°±10.9°），矫正率43.8%~94.4%[（74.8±15）%]。术前静息心率为85.9±12.5次/min，术后1年随访时降低至71.8±9.7次/min（P=0.0000）；术前ACS为47.4±18.2分，术后1年随访时增加至78.3±12.6分（P=0.0000）。术前14例患者左心室舒张功能正常，术后1年随访时25例患者左心室舒张功能正常，其中2例术前左心室舒张功能正常的患者术后1年随访时为左心室舒张功能轻度障碍，临床改善率为72.2%（13/18）。E/A比值术前为1.02±0.36，术后1年随访时增加至1.24±0.27（P=0.0075），术后1年随访时DT由术前234.84±32.46ms缩短至211.56±26.74ms（P=0.0027），术前IVRT为102.50±19.86ms，术后1年随访时减少至87.92±13.12ms（P=0.0010）。术前和术后1年随访时LVEF和LVFS均正常，且无统计学差异（P>0.05）。结论：AS后凸畸形患者PSO术后1年随访时心功能较术前有改善。

英文摘要:

  【Abstract】 Objectives: To observe the postoperative changes in cardiac function of patients with ankylosing spondylitis(AS) kyphosis after the pedicle subtraction osteotomy(PSO). Methods: The original cohort consisted of 36 patients(31 males and 5 females) treated in our hospital from October 2011 to October 2013. The age was 21 to 50 years(39±10 years) and the duration of AS was 5 to 27 years(17±6 years). Echocardiographic measurements, resting heart rate(RHR), active capacity score(ACS), and full-length spine X-ray films in natural standing position were obtained before surgery and at 1-year follow-up. Echocardiographic parameters were measured as follows: left ventricular ejection fraction(LVEF) and left ventricular fraction shortening(LVFS)， mitral early diastolic velocity(E), late diastolic velocity(A), E/A ratio, E deceleration time(DT) and isovolumetric relaxation time(IVRT). And the left ventricular(LV) diastolic function was assessed by the recommendations of American and European Society of Echocardiography. Results: 32 patients(28 males and 4 females) completed the follow-up and 4(3 males and 1 female) patients lost. The preoperative RHR was 85.9±12.5 beats per minute, whereas it was reduced to 71.8±9.7 beats per minute at 1-year follow-up(P=0.0000). The ACS was improved from 47.4±18.2 points preoperatively to 78.3±12.6 points at 1-year follow-up(P=0.0000). 14 patients(2 patients were turned into mild LV diastolic dysfunction at 1-year follow-up) had normal LV diastolic function before operation while there were 25 patients at 1-year follow-up. The clinical improvement rate was 72.2%(13/18). The preoperative DT was 234.84±32.46ms, and it was reduced to 211.56±26.74ms at 1-year follow-up(P=0.0027). The IVRT before PSO was 102.50±19.86ms, while it decreased to 87.92±13.12ms at 1-year follow-up(P=0.0010). The E/A ratio increased from 1.02±0.36 preoperatively to 1.24±0.27 at 1-year follow-up(P=0.0075). Conclusions: The postoperative cardiac function in patients with AS kyphosis is significantly improved at 1-year follow-up.