脊柱后路截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤

The treatment of Andersson lesion with kyphosis in ankylosing spondylitis by posterior wedge osteotomy

中文关键词:  截骨  Andersson损伤  强直性脊柱炎  VAS评分  ODI评分

英文关键词:Osteotomy  Andersson lesion  Ankylosing spondylitis  Visual analog scale  Oswestry disability index

中文摘要:

  【摘要】 目的：探讨脊柱后路经损伤处截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤的临床疗效。方法：回顾性分析2012年1月～2014年1月采用脊柱后路经损伤处截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤的15例患者。男14例，女1例；年龄22～44岁，平均35.7±6.1岁。患者均有腰背痛及后凸畸形，VAS评分6.8±0.8分，ODI为（55.4±12.8）%，局部后凸角51.9°±15.1°，整体后凸角61.6°±27.5°，4例伴有神经功能损伤，术前Frankel分级C级1例，D级3例，E级11例。所有患者均采用后路楔形截骨，术中进行截骨矫形前对Andersson损伤处的纤维组织和硬化骨进行彻底清除直至显露新鲜的松质骨。随访时间均为2年以上，收集患者随访期间的临床疗效评分（VAS和ODI）和影像学参数（局部后凸角、整体后凸角、胸腰段后凸角、腰椎前凸角、骶骨倾斜角和骨盆倾斜角），收集患者术后2年的全脊柱CT检查来评估螺钉置入和固定的情况，应用Bridwell椎间融合评估系统来评估损伤的愈合情况。结果：所有手术均顺利完成，手术时间为279.4±32.9min，术中平均出血量1066.1±466.1ml。1例患者术中出现硬膜破裂，术中修补。1例患者术后出现肺部感染，应用抗生素治疗后痊愈。随访时间24～32个月，平均27.1±2.4个月。术后2年随访时，局部后凸角减小为7.9°±19.0°，平均矫正了44.6°±9.1°。整体后凸角减小为21.3°±10.6°（P<0.05）。腰背疼VAS评分改善为0.7±0.6分（P<0.05），ODI改善为（15.6±4.3）%（P<0.05）。术后2年随访时原神经功能Frankel分级C级1例及D级3例均恢复为E级。CT显示Andersson损伤处均获得骨性融合，无内固定松动、断裂，均为Ⅰ级愈合。结论：脊柱后路经损伤处截骨治疗强直性脊柱炎后凸畸形合并Andersson损伤能够获得良好的融合和矫形效果，临床疗效满意。

英文摘要:

  【Abstract】 Objectives: To assess the efficacy and feasibility of posterior wedge osteotomy in treating kyphosis with Andersson lesion(AL) in ankylosing spondylitis. Methods: 15 ankylosing spondylitis patients(14 males and 1 female) with kyphosis and Andersson lesion with an average age of 35.7±6.1 years old(22-44 years) were retrospectively studied(January 2012 to January 2014). All patients suffered from back pain and severe kyphosis deformity. The local kyphosis(LK) was 51.9°±15.1°, the global kyphosis(GK) was 61.6°±27.5°, the VAS score of back pain was 6.8±0.8 and the ODI was (55.4±12.8)% preoperatively. The Frankel grading of preoperative neurological function was 1 patient in grade C, 3 patients in grade D, and 11 patients in grade E. All patients were performed posterior wedge osteotomy. Before posterior wedge osteotomy, all sclerosis bone was scraped until reaching the healthy cancellous bone. The time of follow-up was at least two years. Radiographic parameters (LK, GK, thoracolumbar kyphosis, lumbar lordosis, pelvic tilt, sacral slope) and clinical efficacies(VAS, ODI) were assessed. The CT scan of the entire spine was obtained preoperatively and at the 2-year follow-up to assess the condition of screw insertion and the healing of fracture. The Bridwell interbody fusion grading system was used to assess the healing of fracture. Results: All patients were operated successfully. The average surgery time was 279.4±32.9min, and the average blood loss was 1066.1±466.1ml. There was one dura tear which was repaired during operation. One patient suffered from pneumonia and recovered after antibiotic treatment. The average time of follow-up was 27.1±2.4 months(24-32 months). At the time of 2-year follow-up, the LK was 7.9°±19.0° with an average correction of 44.6°±9.1°, the GK decreased to 21.3°±10.6°(P<0.05), the VAS scores of back pain improved to 0.7±0.6(P<0.05), the ODI improved to (15.6±4.3)%(P<0.05). The CT scan showed solid fusion at the level of AL, and no loose or breaking of internal fixation. All patients achieved grade 1 healing. No major complication occurred. Conclusions: Posterior wedge osteotomy through AL can be used to correct the kyphosis in ankylosing spondylitis, with good fusion and deformity correction, and with satisfactory clinical outcomes.