强直性脊柱炎后凸畸形的外科治疗

The clinical study of surgical correction for kyphosis deformity in ankylosing spondylitis

目的:探讨以重建强直性脊柱炎(AS)后凸畸形矢状面平衡为目的治疗方法和疗效.方法:18例AS患者,男16例,女2例.根据全脊柱侧位X线片分段测量矢状面不同部位的后凸角度进行分析,明确截骨部位;测量C7铅垂线与S1后上角的距离,了解矢状面不平衡情况;测量颏眉垂线角,确定截骨角度;在纸样上模拟截骨,观察矫形效果.行多节段经椎弓根椎体楔形截骨和椎弓根钉内固定.结果:患者身高平均增高7.3cm,术后颏眉垂线角-5°～10°,术后C7铅垂线距S1椎体后上角0.5～5cm(平均2.4cm),平均改善率为88.8%.经10～38个月(平均22个月)随访,均达骨性融合,矫正度无丢失,无一例脊髓神经损伤,外观改善满意.结论:测量脊柱矢状面不同部位的后凸角度,根据颏眉垂线角,确定截骨部位和后凸角度对于重建矢状面平衡具有重要意义.多节段保留上1/3椎弓根椎体楔形截骨,并应用椎弓根钉内固定系统固定可靠.

Objective:To investigate the operative method of rebuilding the balance of spine in sagittal plane of kyphosis deformity in ankylosing spondylitis,and to evaluate its clinical outcomes.Method:We have measured the segmental cobb angle of total spine in the lateral X-ray film to determine the locations of osteotomy,the neutrality chin brow-vertical angle to determine the angle of osteotomy,and the distance between C7 plumb line to the posteriosuperior corner of S1 to fined out the unbalance of the spine in sagittal plane.The result of correction was prospected through paper model.We have performed 18 cases of kyphosis deformity in ankylosing spondylitis(16 males and 2 females).All cases were performed by multiple segmental transpedicle vertebral bodies subtraction wedge osteotomy and internal fixed using pedicle screw fixation system.Result:The heights of the patients increased 7.3cm on an average,the neutrality chin brow-vertical angles ranged from -5 to 10° after operation,the distances between C7 plumb line to the posteriosuperior corner of S1 vertebrae were 0.5~5cm(average 2.4cm,corrective rate 88.8%) after operation.All cases achieved satisfactory appearance without injury of spinal cord or nerve,and the osteotomed vertebra fused well without losing of corrective rate after 10~38 months(average 22 months) follow-up.Conclusion:Segmental cobb angle in sagittal plane and neutrality chin brow-vertical angle are very important to rebuild the balance of spine in sagittal plane.After multiple segmental transpedicle vertebral bodies subtraction wedge osteotomy,spinal stability can be reconstructed stably by pedicle screw fixation system.