强直性脊柱炎胸腰椎后凸畸形截骨角度术前预测方法的评价

Evaluation of preoperative prediction methods for osteotomy angle of ankylosing spondylitis thoracolumbar kyphosis

中文关键词:  强直性脊柱炎  脊柱后凸  截骨角度预测

英文关键词:Ankylosing spondylitis  Kyphosis  Osteotomy angle prediction

中文摘要:

  【摘要】 目的：评价强直性脊柱炎胸腰椎后凸畸形截骨角度的术前预测方法，分析其在脊柱-骨盆矢状序列重建中的临床价值。方法：回顾性分析2015年1月～2022年1月在新疆医科大学第一附属医院行单节段经椎弓根截骨（pedicle subtraction osteotomy，PSO）治疗的22例强直性脊柱炎胸腰椎后凸畸形患者，其中男17例，女5例；年龄29~56岁（44.3±7.4岁）；在X线侧位片上测量术前、术后末次随访时的脊柱-骨盆参数，应用躯干整体平衡法（full balance integated index，FBI）、脊柱股骨角法（spine femoral angle，SFA）、肺门-髋轴法（hilus pulmonis-hip axis，HP-HA）、外耳道-髋轴法（center of both acoustic meati-hip axis，CAM-HA）和Surgimap法预测截骨角度，再根据骨盆入射角（pelvic incidence, PI）计算理论脊柱-骨盆参数和理论截骨角度。分别比较术前、术后末次随访时和理论脊柱-骨盆参数的差异以及预测截骨角度、实际截骨角度和理论截骨角度的差异。结果：纳入患者中L1截骨4例、L2截骨10例、L3截骨8例，术后均获得满意的影像学结果和手术疗效，术后末次随访时骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）、腰椎前凸角（lumbar lordosis，LL）、胸椎后凸角（thoracic kyphosis，TK）、胸腰段后凸角（thoracolumbar kyphosis，TLK）、整体后凸角（global kyphosis，GK）、矢状面偏移（sagittal vertical axis，SVA）与术前比较差异均有统计学意义（P<0.05）。FBI、SFA、HP-HA、CAM-HA和Surgimap法预测截骨角度分别为50.5°±12.1°、52.0°±11.3°、53.9°±8.1°、51.3°±5.8°和43.2°±9.2°，不同预测方法预测的截骨角度比较差异有统计学意义（F=2.342，P=0.046）。模拟截骨恢复理想脊柱-骨盆矢状序列所需理论截骨角度为51.2°±8.1°，分别与FBI、SFA、HP-HA、CAM-HA预测截骨角度比较均无统计学差异（P>0.05）。术中实际截骨角度41.1°±5.4°，与FBI、SFA、HP-HA、CAM-HA预测截骨角度比较均有统计学差异（P<0.05），与Surgimap法预测截骨角度比较无统计学差异（P>0.05）。结论：对强直性脊柱炎胸腰椎后凸畸形术前采用FBI、SFA、HP-HA、CAM-HA预测的截骨角度与理论截骨角度相近，与实际截骨角存在一定的差异；Surgimap法预测的截骨角度与实际截骨角度相近。

英文摘要:

  【Abstract】 Objectives: To evaluate the preoperative prediction methods of osteotomy angle of thoracolumbar kyphosis in ankylosing spondylitis(AS) patients, and to analyze their clinical values in reconstruction of spinopelvic sagittal alignment. Methods: 22 AS patients with thoracolumbar kyphosis, who underwent single segment pedicle subtraction osteotomy(PSO) from January 2015 to January 2022 in the First Affiliated Hospital of Xinjiang Medical University, were retrospectively reviewed. There were 17 males and 5 females with a mean age of 44.3±7.4 years(range, 29-56 years). Preoperative and postoperative spinopelvic parameters were measured on X-ray lateral radiographs, osteotomy angles were predicted with different methods, full balance integated index(FBI), spine femoral angle(SFA), hilus pulmonis-hip axis(HP-HA), center of both acoustic meati-hip axis(CAM-HA), and Surgimap method. And theoretical spinopelvic parameters and theoretical osteotomy angle were calculated according to pelvic incidence(PI). The differences between preoperative, final follow-up and theoretical spinopelvic parameters, and between the predictive, actual and theoretical osteotomy angles, were compared. Results: The osteotomy sites of the 22 cases included 4 in L1, 10 in L2 and 8 in L3. All the patients achieved ideal imaging and surgical results. The differences in pelvic tilt(PT), sacral slope(SS), lumbar lordosis(LL), thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), global kyphosis(GK), and sagittal vertical axis(SVA) between final follow-up and preoperation were statistically significant(P<0.05). The osteotomy angles predicted with FBI, SFA, HP-HA, CAM-HA, and Surgimap methods were 50.5°±12.1°, 52.0°±11.3°, 53.9°±8.1°, 51.3°±5.8°, and 43.2°±9.2°, respectively, with statistically significant differences(F=2.342，P=0.046). The theoretical osteotomy angle required by simulated osteotomy to restore the ideal spinopelvic sagittal alignment was 51.2°±8.1°, which wasn′t statistically different from the osteotomy angles predicted with FBI, SFA, HP-HA or CAM-HA methods(P>0.05). The actual osteotomy angle during the operation was 41.1°±5.4°, which was statistically different from the osteotomy angles predicted with FBI, SFA, HP-HA and CAM-HA methods(P<0.05), but not statistically different with the angle predicted with Surgimap method(P>0.05). Conclusions: The osteotomy angles predicted with FBI, SFA, HP-HA, and CAM-HA methods are similar with the theoretical osteotomy angle, while different from the actual osteotomy angle to some extent; The osteotomy angle predicted with Surgimap method is similar with the actual osteotomy angle.