跳跃式双节段经椎弓根截骨长节段融合治疗强直性脊柱炎胸腰椎后凸畸形

The skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation for ankylosing spondylitis thoracolumbar kyphosis deformity

中文关键词:  强直性脊柱炎  后凸畸形  胸腰椎  截骨术  内固定

英文关键词:Ankylosing spondylitis  Kyphosis  Thoracolumbar  Osteotomy  Internal fixation

中文摘要:

  【摘要】 目的：探讨跳跃式双节段经椎弓根截骨长节段融合治疗强直性脊柱炎（AS）胸腰椎后凸畸形的安全性及有效性。方法：2011年10月~2015年10月采用跳跃式双节段经椎弓根截骨长节段融合内固定治疗25例AS胸腰椎后凸畸形患者，均为男性，年龄39.0±7.2岁，记录手术时间，术中出血量，术前、术后患者胸腰椎后凸Cobb角、腰椎前凸Cobb角、颌眉角、脊柱矢状面偏移（SVA）、骨盆入射角（PI）、骨盆倾斜角（PT）、骶骨倾斜角（SS）及Oswestry功能障碍指数（ODI），观察术后相关并发症的发生情况等。结果：患者均顺利完成手术，手术时间396.4±51.5min，术中出血量1612.0±490.2ml，2例患者术中硬脊膜破裂，及时修补，术后未出现脑脊液漏；无其他严重并发症发生。所有患者均得到有效随访，随访时间19.0±6.6个月，患者活动能力及生活质量明显提高，ODI由术前33.9±6.5分降至术后6个月8.5±3.6分，末次随访时为6.8±5.0分，术后6个月及末次随访时与术前比较均有统计学差异（P＜0.05）；末次随访时与术后6个月亦有统计学差异（P＜0.05）。术后2周及末次随访时的颌眉角、胸腰椎后凸Cobb角、腰椎前凸Cobb角、SVA、PT、SS与术前比较差异均有统计学意义（P＜0.05），PI无统计学差异；末次随访时颌眉角、胸腰椎后凸Cobb角、腰椎前凸Cobb角、SVA、PT与术后2周比较有统计学差异（P＜0.05）；SS、PI与术后2周时比较无统计学差异（P＞0.05）。末次随访时均未见内固定物松动、脱出及断裂，植骨均骨性融合。结论：跳跃式双节段经椎弓根截骨长节段融合术治疗AS胸腰椎后凸畸形安全、有效。

英文摘要:

  【Abstract】 Objectives: To evaluate the safety and efficacy of the skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation in ankylosing spondylitis(AS) thoracolumbar kyphosis deformity. Methods: Twenty-five AS patients with thoracolumbar kyphosis were treated by skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation from October 2011 to October 2015. The patients were all male with a mean age of 39.0±7.2 years. The preoperative and postoperative data were collected: thoracolumbar kyphosis, lumbar lordosis, chin-brow angle, the sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope(SS), the Oswestry disability index(ODI). The operation time, intraoperative blood loss and complications were recorded. Results: All the surgeries went well with a mean operation time of 396.4±51.5min and a mean intraoperative blood loss of 1612.0±490.2ml. Mild dural ruptures occurred in 2 patients which were repaired and no cerebrospinal fluid leakage was found after operation. There were no serious complications in all the patients. The patients were followed up for a mean time of 19.0±6.6 months. The patients′ activity ability and life quality improved obviously. ODI at 6 months after operation and at the last follow-up was 8.5±3.6 points and 6.8±5.0 points, which all obviously reduced when compared with preoperative ODI of 33.9±6.5 points(P<0.05). Meanwhile, there was a significant difference between ODI at 6 months after operation and that at the last follow-up. The chin-brow angle, thoracolumbar kyphosis angle, lumbar lordosis angle, SVA, PT and SS at 2 weeks after operation and at the last follow-up had significant differences(P<0.05), but the PI between at the two time points had no statistically significant difference(P＞0.05). There were significant differences of chin-brow angle, thoracolumbar kyphosis angle, lumbar lordosis angle, SVA and PT between 2 weeks after operation and the last follow-up(P<0.05), but there was no significant difference of SS or PI between the two time points(P＞0.05). At the last follow-up, no failure of internal fixation was found, and all the bone grafts were solidly fused. Conclusions: The skipping double-segmental transpedicular osteotomy and long segment pedicle screw fixation is a relatively safe and effective method for AS thoracolumbar kyphosis, but surgeons should follow indication strictly in surgical choice.