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

[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。

[ Objective] To assess the outcomes of lumbar spinal pedicle subtraction osteotomy on single segment for correction of kyphosis in ankylosing spindylitis. [ Methods] 15 patients were treated with L2 or L3 pedicle subtraction osteotomy and internal fixation by pedicle screw system. All the patients underwent X-ray examinations in standing position before and after the operations. The angles in different part of the sagittal planes were measured and the preoperative and postoperative differences were compared. [Results] All the operations were well complete. The mean time of operations was 3h and the mean bleeding was 840 ml. The lumbar lordosis angle increase from （ 14. 5 ± 15.5 ）° to （48. 4 ± 11.9）°, the total spinal kyphosis angle and the thoracolumbar kyphosis angle improve from （36. 1 ± 14. 7）° and （30. 7±9. 3）° to （0. 2 ±14. 2）° and （23.7 ± 12. 3）° respectively, the sacral slope increase from （12. 0 ± 12. 7）° to （28. 9 ± 8. 8）°, whereas thoracic kypbesis angle remained relative stable. [ Conclusion] Lumbar spinal pedicle subtraction ostcotomy on single segment is a satisfactory and reliable technique for correction of kyphosis in ankylosing spindylitis and the average correction of lumbar lordosis was 33. 9°.