强直性脊柱炎患者胸腰椎后凸畸形矫形术后骨盆旋转与截骨部位和截骨角度间的关系

Relationship between postoperative pelvic rotation and osteotomy site and angle in thoracolumbar kyphosis of ankylosing spondylitis

中文关键词:  强直性脊柱炎  胸腰椎后凸畸形  骨盆旋转  截骨部位  截骨角度

英文关键词:Ankylosing spondylitis  Thoracolumbar kyphosis  Pelvic rotation  Osteotomy site  Osteotomy angle

中文摘要:

  【摘要】 目的：探讨强直性脊柱炎（ankylosing spondylitis，AS）胸腰椎后凸畸形患者截骨矫形术后骨盆旋转与截骨部位和截骨角度间的关系。方法：回顾性分析2017年8月~2021年4月于我院行双节段经椎弓根椎体截骨矫形术（pedicle subtraction osteotomy，PSO）治疗的AS胸腰椎后凸畸形患者的资料13例，男11例，女2例，年龄43.5±8.5岁（29~58岁）。所有患者均顺利实施脊柱双节段PSO，PSO截骨26处，截骨角度35.6°±9.0°，手术时间434.2±117.1min，术中出血量2480.5±1486.3mL；随访29.0±4.0个月（24~38个月）。在术前、术后2周及末次随访时的脊柱全长侧位X线片上测量全脊柱后凸角（global kyphosis，GK）、胸椎后凸角（thoracic kyphosis，TK）、腰椎前凸角（lumbar lordosis，LL）、矢状面躯干偏移（sagittal vertical axis，SVA）、肺门距髋轴水平距离（horizontal distance between hip axis and hilus pulmonis，HDHH）、骨盆倾斜角（pelvic tilt，PT）、骶骨倾斜角（sacral slope，SS）及骨盆投射角（pelvic incidence，PI）；记录术后2周和末次随访时PT与术前相比的变化值（ΔPT），即术后骨盆旋转角，分别记为术后2周ΔPT、末次随访ΔPT；在术后2周胸腰椎CT片上测量截骨角度；在术前脊柱全长侧位X线片上以髋轴为原点建立平面坐标轴，测量髋轴（hip axis，HA）、肺门（hilus pulmonis，HP）及截骨顶点间的距离及角度值，用截骨顶点的坐标及与HA、HP的距离、角度值来表示截骨部位，推算矫形术后骨盆旋转角度与截骨部位、截骨角度间的函数关系，得到公式推算的ΔPT值。采用配对t检验分别比较公式推算ΔPT值与术后2周和末次随访时ΔPT间的差异，验证公式的准确性。结果：患者术前GK、LL、SVA、HDHH、SS、PT分别为94.8°±15.1°、-17.0°±24.9°、29.4±6.9cm、10.3±8.8cm、5.7°±10.3°、43.6°±14.5°，术后2周分别为34.0°±18.5°、34.1°±15.1°、10.4±4.5cm、1.7±4.7cm、24.6°±7.1°、24.5°±8.3°，末次随访时分别为34.2°±18.0°、36.9°±19.4°、9.8±4.0cm、1.2±3.3cm、24.8°±7.3°、25.1°±7.8°，术前与术后2周比较上述指标间均有显著统计学差异（P＜0.05）；术前TK和PI分别为51.6°±19.4°、49.3°±10.5°，术后2周分别为45.8°±18.7°、48.8°±12.0°，术前与术后2周比较无统计学差异（P＞0.05）；术后2周与末次随访时的GK、TK、LL、SVA、HDHH、PI、SS、PT均无统计学差异（P＞0.05）。推算的ΔPT为17.8°±8.9°、实际测得术后2周ΔPT为19.2°±8.6°，末次随访ΔPT为18.5°±8.4°，三者间均无统计学差异（P＞0.05）。结论：AS胸腰椎后凸畸形患者截骨矫形术后骨盆旋转与截骨部位、截骨角度间存在函数关系。

英文摘要:

  【Abstract】 Objectives: To explore the relationship between pelvic rotation, osteotomy site and osteotomy angle in patients with thoracolumbar kyphosis of ankylosing spondylitis(AS). Methods: 13 AS patients with thoracolumbar kyphosis, who underwent double-level pedicle subtraction osteotomy(PSO) between August 2017 and April 2021, were retrospectively analyzed. There were 11 males and 2 females, aged 43.5±8.5 years(29-58 years). A total of 26 PSO osteotomy were performed. The osteotomy angle was 35.6°±9.0°, the operative time was 434.2±117.1min, and the intraoperative blood loss was 2480.5±1486.3mL. The follow-up time was 29.0±4.0months(24-38months). The global kyphosis(GK), thoracic kyphosis(TK), lumbar lordosis(LL), sagittal vertical axis(SVA), horizontal distance between hip axis and hilus pulmonis(HDHH), pelvic tilt(PT), sacral slope(SS), and pelvic incidence(PI) were measured on the preoperative, two weeks postoperative, and final follow-up full-length lateral radiographs of the spine. The changes in PT(ΔPT) at two weeks after operation and final follow-up from the preoperative PT value were recorded, namely, postoperative pelvic rotation angle, which were recorded as two weeks-postoperative ΔPT and final follow-up ΔPT, respectively. The osteotomy angle was measured and recorded on the thoracolumbar CT two weeks after operation. The distances and angles between hip axis(HA), hilus pulmonis(HP) and the osteotomy apex were measured in the plane coordinate axis with the hip axis as the origin established on the preoperative full-length lateral spine X-ray film. The coordinate of the apex and the distances to and angles with HA and HP were used to represent the osteotomy site. The functional relationship between the pelvic rotation angle and the osteotomy site and osteotomy angle was calculated, and the ΔPT value calculated by the formula was obtained. Paired t test was used to verify the accuracy of the formula by comparing the ΔPT calculated by the formula with the ΔPT of 2 weeks after operation and the ΔPT of the final follow-up. Results: The GK, LL, SVA, HDHH, SS, and PT were 94.8°±15.1°,-17.0°±24.9°, 29.4±6.9cm, 10.3±8.8cm, 5.7°±10.3°, and 43.6°±14.5°, respectively before operation, which were 34.0°±18.5°, 34.1°±15.1°, 10.4±4.5cm, 1.7±4.7cm, 24.6°±7.1°, and 24.5°±8.3° two weeks after operation, and 34.2°±18.0°、36.9°±19.4°、9.8±4.0cm、1.2±3.3cm、24.8°±7.3°, and 25.1°±7.8° at final follow-up. The above indexes two weeks after operation were significantly different from those before operation(P<0.05). The TK and PI were 51.6°±19.4° and 49.3°±10.5° before operation, and 45.8°±18.7° and 48.8°±12.0° two weeks after surgery, with no significant difference(P>0.05). There was no significant difference in GK, TK, LL, SVA, HDHH, PI, SS, and PT between two weeks after operation and final follow-up(P>0.05). The formula-calculated ΔPT, two-weeks postoperative ΔPT, and final follow-up ΔPT were 17.8°±8.9°, 19.2°±8.6°, and 18.5°±8.4°, respectively, with no significant statistical differences between(P>0.05). Conclusions: There is an function relationship between the pelvic rotation after osteotomy in AS patients with thoracolumbar kyphosis and the site and angle of osteotomy.