强直性脊柱炎胸腰段脊柱后凸截骨术矢状面移位患者椎管自发重塑形现象

Spontaneous remodeling of spinal canal after sagittal translation in the osteotomy for thoracolumbar kyphosis in ankylosing spondylitis

中文关键词:  强直性脊柱炎  经椎弓根截骨术  矢状面移位  椎管重塑形

英文关键词:Ankylosing spondylitis  Pedicle subtraction osteotomy  Sagittal translation  Spinal canal remodeling

中文摘要:

  【摘要】 目的：观察强直性脊柱炎（ankylosing spondylitis，AS）脊柱后凸畸形截骨术发生矢状面移位（sagittal translation，ST）患者椎管形态的变化以及椎管自发重塑形现象。方法：回顾性分析2011年1月~2014年12月于我院行经椎弓根截骨术发生ST的16例AS胸腰段脊柱后凸畸形患者，男14例，女2例，年龄28~55岁（38.6±8.4岁）。均于手术前后及末次随访时拍摄自然站立位全脊柱正侧位X线片以及ST节段三维CT扫描，分别测量全脊柱后凸角（GK）、胸腰段后凸角（TLK）、腰前凸角（LL）、矢状面偏移（SVA）以及ST的大小，观察术后及末次随访时ST的变化以及椎管形态的改变，并于术前及末次随访时通过SRS问卷对患者生活质量进行评估。结果：所有患者均获得随访，随访时间12~36个月（22.0±8.5个月），随访期内所有病例均未出现内固定失败。术前GK为59.9°±21.0°、TLK为38.0°±13.0°、LL为7.4°±26.5°、SVA为27.2±8.6mm，术后末次随访时GK为15.7°±2.1°、TLK为5.6°±2.6°、LL为-36.1°±2.9°、SVA为6.1±4.3mm，末次随访时所有患者ST均有改善，ST由术后7.1±2.7mm减小为末次随访时的1.2±1.0mm，差异有统计学意义（P<0.05），ST变化率为（84.9±9.7）%。4例患者出现神经并发症。SRS满意度调查术前评分为1.6±0.3分，末次随访时评分为4.7±0.4分，差异有统计学意义（P<0.05）。末次随访时截骨节段的椎管形态均有不同程度的自发重塑形。结论：AS脊柱胸腰段后凸畸形截骨术发生ST的患者术后均会发生不同程度的椎管自发重塑形，经过重塑形ST均不同程度的减小甚至消失。

英文摘要:

  【Abstract】 Objectives: To observe the transformation of spinal canal in patients with sagittal translation(ST) after osteotomy in ankylosing spondylitis(AS) kyphosis, and to investigate the spontaneous remodeling of spinal canal in these patients. Methods: Retrospective analysis was conducted on 16 patients with ST after the treatment of AS kyphosis through pedicle subtraction osteotomy(PSO) during January 2011 to December 2014 in our hospital, 14 males and 2 females, aged 28-55 years old(38.6±8.4 years old). Full-length free-standing spinal radiographs and computed tomography of ST level were available for all the patients before and after surgery, also at the final follow-up. Radiographic parameters including global kyphosis (GK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), sagittal vertical axis(SVA) and ST were measured. The change of ST and transformation of spinal canal after surgery and at the final follow-up were compared. The SRS scores before surgery and at the final follow-up were also collected. Results: The average follow-up time was 22.0 months, ranged from 12 to 36 months. There was no internal fixation failure during this period. The preoperative GK was 59.9°±21.0°, TLK was 38.0°±13.0°, LL was 7.4°±26.5°, SVA was 27.2±8.6mm. And the postoperative GK was 15.7°±2.1°, TLK was 5.6°±2.6°, LL was -36.1°±2.9°, SVA was 6.1±4.3mm. ST was 7.1±2.7mm after surgery while 1.2±1.0mm at the final follow-up, the difference was statistically significant(P<0.05). The rate of ST transformation was (84.9±9.7)%. 4 among 16 patients experienced neurological deficits(incidence of neurological deficits was 25%). The SRS scores before operation and at the final follow-up were 1.6±0.3 and 4.7±0.4 respectively(P<0.05). The remodeling of spinal canal occured in all the patients with different degrees. Conclusions: All patients with ST after PSO for AS kyphosis experience spontaneous remodeling of spinal canal, and ST decreases or even disappeares in different degrees.