腰椎后路截骨矫正强直性脊柱炎合并重度胸腰椎后凸畸形的临床疗效

Clinical effect of posterior lumbar osteotomy on severe thoracolumbar kyphosis complicated with ankylosing spondylitis

目的评估腰椎后路截骨手术矫正强直性脊柱炎(ankylosing spondylitis,AS)合并重度胸腰椎后凸畸形的临床疗效。方法2020-10至2021-06共收治AS合并胸腰椎后凸畸形患者11例,其中合并Andersson损害(Andersson lesion,AL)1例,平均(32.8±3.4)岁;患者均有腰背部疼痛及后凸畸形,术前胸椎后凸角59.36°±12.63°;腰椎前凸角-0.54°±32.89°;颏眉角31.82°±12.25°。10例AS后凸畸形患者均在L行经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO),1例AS合并AL后凸畸形患者采用腰椎后路经损害处清创、截骨矫形。综合评价术后影像学、临床疗效及并发症。结果患者手术顺利,耐受性良好,术后平均胸椎后凸角55.18°±11.59°,腰椎前凸角43.91°±19.14°,颏眉角1.82°±0.83°。患者均获随访,无血管、神经损伤,无应力性骨折等并发症。结论经L行PSO截骨矫正AS重度后凸畸形,合并AL后凸畸形行经损伤处截骨矫形,术后效果安全可靠。

Objective To evaluate the clinical efficacy of posterior lumbar osteotomy in the correction of severe thoracolumbar kyphosis complicated with ankylosing spondylitis(AS).Methods From October 2020 to June 2021,ten patients with thoracolumbar kyphosis complicated with AS and one patient complicated with Andersson lesion(AL)were treated,with an average age of 32.8±3.4 years;All patients had low back pain and kyphosis deformity.The preoperative thoracic kyphosis angle was 59.36°±12.63°,with lumbar lordosis angle of-0.54°±32.89°and chin eyebrow angle of 31.82°±12.25°.The above ten patients underwent pedicle subtraction osteotomy(PSO)in L,and the only one patient was treated with posterior lumbar debridement and osteotomy.Comprehensive evaluation of postoperative imaging,clinical efficacy and complications were performed.Results The operation was successful and well tolerated.The average postoperative thoracic kyphosis angle was 55.18°±11.59°,with lumbar lordosis of 43.91°±19.14°and chin eyebrow angle of 1.82°±0.83°.All patients were followed up without vascular and nerve injury,stress fracture or other major complications.Conclusion PSO correction through Lfor severe kyphosis complicated with AS and the osteotomy in treating kyphosis combined with AL are safe and reliable.