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Lumbar spinal pedicle subtraction osteotomy on single segment for correction of kyphosis in ankylosing spondylitis
李景欣;瞿东滨;金大地;
摘要(Abstract)：
[目的]评价腰椎单节段经椎弓根椎体截骨术治疗强直性脊柱炎后凸畸形的临床疗效。[方法]15例强直性脊柱炎后凸畸形患者,行后路L2或L3经椎弓根椎体截骨及椎弓根系统内固定术。手术前、后均行站立位胸腰椎X线检查,分别测量矢状面上不同部位的角度,并分别比较手术前后的差异。[结果]均顺利完成截骨矫形手术,手术时间2.5～4h,平均3h。术中出血600～1500ml,平均840ml,均采用自体血回输技术,无严重手术并发症发生。腰椎前凸角由术前(14.5±15.5)°增加至术后(48.4±11.9)°,全脊柱后凸角和胸腰段后凸角分别由术前(36.1±14.7)°和(30.7±9.3)°减小至术后(0.2±14.2)°和(23.7±12.3)°,骶骨倾斜角由术前(12.0±12.7)°增至术后(28.9±8.8)°,手术前后均有统计学差异;而胸椎后凸角手术前后改变不明显。[结论]采用腰椎单节段经椎弓根椎体截骨术治疗强直性脊柱炎后凸畸形,腰椎前凸角平均增加33.9°,可获得较满意的矫形效果。
关键词(KeyWords)： 强直性脊柱炎;腰椎;后凸畸形;经椎弓根椎体截骨术
基金项目(Foundation):
作者(Author): 李景欣;瞿东滨;金大地;
Email:
DOI:
参考文献(References)：
- [1]Chang KW,Chen YY,Lin CC,et al.Closing wedge osteotomy versus o-pening wedge osteotomy in ankylosing spondylitis with thoracolumbar kyphotic deformity[J].Spine,2005,14:1584-1593.
- [2]邱勇,朱泽章,吕锦瑜,等.强直性脊柱炎胸腰椎后凸畸形两种截骨矫形术式的疗效比较[J].中华骨科杂志,2002,12:719-722.
- [3]Bridwell KH,Lewis SJ,Lenke LG,et al.Pecicle subtraction osteotomy for the treatment of fixed sagittal imbalance[J].J Bone Jiont Surg(Am),2003,3:454-463.
- [4]Chen IH,Chien JT,Yu TC.Transpedicular wedge osteotomy for correc-tion of thoracolumbar kyphosis in ankylosing spondylitis:experience with78patients[J].Spine,2001,16:354-360.
- [5]Suk KS,Kim KT,Lee SH,et al.Significance of chin-brow vertical an-gle in correction of kyphotic deformity of ankylosing spondylitis pa-tients[J].Spine,2003,17:2001-2005.
- [6]Min K,Hahn F,Leonardi M.Lumbar spinal osteotomy for kyphosis in ankylosing spondylitis:the significance of the whole body kyphosis an-gle[J].J Spinal Disord Tech,2007,2:149-153.
- [7]Tokala DP,Lam KS,Freeman BJ,et al.C7decancellisation closing wedge osteotomy for the correction of fixed cervico-thoracic kyphosis[J].Eur Spine J,2007,9:1471-1478.
- [8]田慧中,吕霞,田斌,等.强直性脊柱炎颈胸段后凸畸形截骨矫正术[J].中国矫形外科杂志,2006,7:522-523.