吴继彬;郭开今;袁峰;张新珠;吴东迎;孙玛骥;

• 1:徐州医学院附属医院骨科

摘要(Abstract)：

[目的]探讨单节段经腰椎椎弓根截骨术治疗强直性脊柱炎后凸畸形的临床效果。[方法]2010年9月~2014年9月,采用单节段经腰椎椎弓根截骨术治疗13例强直性脊柱炎后凸畸形患者。其中男11例,女2例;年龄32~71岁,平均51.4岁,病程5~39年。在术前、术后及随访时矢状面X线片上测量腰椎前凸、胸椎后凸、全脊柱最大后凸Cobb角及矢状面平衡,拍摄大体像测定颌眉角,采用Bridwell-Dewald脊柱疾患疼痛及功能评定标准评价临床效果及患者生活质量。[结果]所有患者均获得随访,平均随访时间16.5个月(12~36个月)。术中出血量(2 100±550.7)ml(1 500~2 800 ml)。术中硬膜破裂1例,一侧下肢神经症状1例,经治疗后均恢复良好。术后1周时测量,全脊柱最大后凸Cobb角矫正到(30.8±3.8)°,颌眉角改善到(3.2±1.3)°,C_7铅垂线距S1后上角的距离改善到(4.3±1.2)cm。术后1周全脊柱最大后凸Cobb角、胸椎后凸角、胸腰段后凸角、腰椎前凸角、颌眉角和C_7铅垂线距S_1后上角距离均较术前明显改善(P<0.05)。末次随访时,上述指标与术后1周比较差异无统计学意义(P>0.05)。患者均能平视、直立行走及平卧,截骨处均达骨性融合,末次随访时疼痛、工作限制情况及社交限制情况较术前明显改善(P<0.05)。[结论]单节段经腰椎椎弓根截骨术治疗强直性脊柱炎后凸畸形可获得满意的临床效果。

关键词(KeyWords)： 强直性脊柱炎;后凸畸形;经椎弓根椎体截骨术;矢状面平衡

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 吴继彬;郭开今;袁峰;张新珠;吴东迎;孙玛骥;

Email:

DOI:

参考文献(References)：

• [1]刘越,赵艳梅,夏群.强直性脊柱炎的诊断与治疗进展[J].中国矫形外科杂志,2015,23(3):235-238.
• [2]李景欣,瞿东滨,金大地.腰椎单节段经椎弓根椎体截骨术矫治强直性脊柱炎后凸畸形[J].中国矫形外科杂志,2008,14(3):182-184.
• [3]钱邦平,邱勇,王斌,等.强直性脊柱炎胸腰椎后凸畸形的手术矫形时机选择[J].中华风湿病学杂志,2007,11(2):101-104.
• [4]刘少华,张宏其,刘金洋,等.后路经椎弓根闭合性楔形截骨治疗强直性脊柱炎所致脊柱后凸畸形[J].中国矫形外科杂志,2012,20(17):1556-1559.
• [5]Bridwell KH,Dewald RL.The textbook of spinal surgery[M].2nded.Philadelphia:Lippincoast Raven,1997:1503-1545.
• [6]Liu H,Yang C,Zheng Z,et al.Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2015,40:570-579.
• [7]Smith-Petersen MN,Aufranc OE.Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis[J].J Bone Joint Surg Am,1945,27(1):1-11.
• [8]Chang KW,Chen HC,Chen YY,et al.Sagittal translation in opening wedge osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis[J].Spine(Phila Pa 1976),2006,31(10):1137-1142.
• [9]Thomasen E.Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis[J].Clin Orthop,1985,194(194):142-152.
• [10]钱邦平,季明亮,邱勇,等.经椎弓根截骨对强直性脊柱炎胸腰椎后凸畸形脊柱-骨盆参数的影响[J].中华骨科杂志,2012,32(5):398-403.
• [11]王鑫强,钱邦平,邱勇.强直性脊柱炎患者骨质疏松的研究进展[J].中国矫形外科杂志,2012,17(13):1212-1214.
• [12]Qian BP,Jiang J,Qiu Y,et al.Radiographical predictors for postoperative sagittal imbalance in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis after lumbar pedicle subtraction osteotomy[J].Spine(Phila Pa 1976),2013,38(26):1669-1675.
• [13]Chang KW,Tu MY,Huang HH,et al.Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis[J].Spine(Phila Pa 1976),2006,31(13):408-413.