单纯后柱缩短截骨矫形治疗强直性脊柱炎后凸畸形合并病理性骨折Single posterior column shortening osteotomy for treatment of kyphosis in ankylosing spondylitis patients with pathological fracture
张宏其;周振海;郭超峰;王昱翔;唐明星;余洪贵;尹新华;
摘要(Abstract):
[目的]评价通过经骨折线单纯后柱缩短截骨矫形治疗强直性脊柱炎后凸畸形合并病理性骨折的疗效。[方法]收集本中心强直性脊柱炎后凸畸形合并病理性骨折行经骨折线单纯后柱缩短截骨矫形的手术患者13例;年龄22~52岁,平均36.8岁。通过术前术后VAS评分,术前、术后及随访时矢状面X线片,测量全脊柱后凸角、胸腰段后凸角、腰椎前凸角、C_7铅垂线和S_1后上角的距离,评价症状改善及矫形效果。[结果]13例患者平均随访2.1年,其中2例未满1年(1例6个月,1例3个月),1例患者术后出现手术切口感染,经更换抗生素后治愈。所有患者脊柱后凸角(GK)从术前平均(55.8±11.0)°下降到术后平均(23.2±6.7)°,P<0.001;C7铅垂线至骶骨后上角的距离(C_7~S_1)从术前的平均(166±37)mm下降到术后的平均(111±20)mm,P<0.001;胸腰段后凸角(TLK)从术前的平均(51.0±9.9)°下降到术后平均(21.6±11.0)°;P<0.001;患者疼痛视觉模拟评分(VAS评分)从术前平均(7.2±1.2)分下降到术后平均(2.1±1.1)分,P<0.001;腰椎前凸角(LL)从术前平均(5.7±23.2)°增加到术后平均(10.5±29.0)°,P=0.001。[结论]经病理性骨折线单纯后柱缩短截骨矫形是治疗强直性脊柱炎后凸畸形合并病理性骨折的有效方法,可在显著改善患者腰背部疼痛症状的同时取得良好的矫形效果。
关键词(KeyWords): 强直性脊柱炎;后凸畸形;病理性骨折;截骨矫形
基金项目(Foundation): 国家自然科学基金资助项目(编号:81472145);; 湖南省“芙蓉学者”项目
作者(Author): 张宏其;周振海;郭超峰;王昱翔;唐明星;余洪贵;尹新华;
Email:
DOI:
参考文献(References):
- [1]Zhang HQ,Huang J,Guo CF,et al.Two-level pedicle subtraction osteotomy for severe thoracolumbar kyphotic deformity in ankylosing spondylitis[J].Eur Spine J,2014,23(1):234-241.
- [2]Schwab F,Blondel B,Chay E,et al.The comprehensive anatomical spinal osteotomy classification[J].Neurosurgery,2015,74(1):112-120.
- [3]Arun R,Dabke HV,Mehdian H.Comparison of three types of lumbar osteotomy for ankylosing spondylitis:a case series and evolution of a safe technique for instrumented reduction[J].Eur Spine J,2011,20(12):2252-2260.
- [4]Kim KT,Park KJ,Lee JH.Osteotomy of the spine to correct the spinal deformity[J].Asian Spine J,2009,3(2):113-123.
- [5]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.
- [6]曾岩,陈仲强,郭昭庆,等.强直性脊柱炎后凸畸形的后路截骨矫形术及疗效分析[J].中华外科杂志,2010,48(16):1234-1237.
- [7]张国华,陈鸿昌,陈盈佑,等.后路截骨矫形固定融合治疗强直性脊柱炎假关节并脊柱后凸畸形[J].中国脊柱脊髓杂志,2006,16(5):358-361.
- [8]Barrey C,Perrin G,Michel F,et al.Pedicle subtraction osteotomy in the lumbar spine:indications,technical aspects,results and complications[J].Eur J Orthop Surg Traumatol,2014,24(S1):21-30.
- [9]Qian BP,Qiu Y,Wang B,et al.Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis[J].Eur Spine J,2012,21(4):711-718.
- [10]Chen IH,Chien JT,Yu TC.Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis:experience with 78 patients[J].Spine(Phila Pa 1976),2001,26(16):354-360.