后路经关节突截骨术治疗强直性脊柱炎后凸畸形的中短期随访

The middle term follow-up results of posterior transfacet osteotomy used in the treatment of ankylosis spondylitis kyphosis deformity

目的探讨强直性脊柱炎后凸畸形采用后路多节段经关节突截骨术治疗的临床疗效和中短期随访结果。方法2000年12月至2006年12月间共收治强直性脊柱炎伴胸椎后凸畸形患者12例，男8例，女4例；年龄18-32岁，平均25-42岁。后凸畸形的顶点部位主要分布在胸腰椎区域，分布于胸腰椎者有7例，分布于腰椎者有5例。采用后路经关节突多节段截骨术进行手术治疗，截骨平面2-4个，观察手术前后患者的矫形效果、植骨融合情况以及并发症发生情况。使用SPSS 15．0统计软件进行处理，比较手术前后矫形效果的差异和并发症发生情况。结果12例患者手术后无感染、死亡病例发生；术中硬膜撕裂1例，椎弓根骨折1例，术后下肢一过性感觉减退1例。术后平均矫正25°。随访时间1．25-6年，平均3．5年。矫正度数丢失平均为7．2°，但是所有患者都达到了骨性融合。所有病例中有1例出现螺钉松动。患者的主观满意度是96．7％。结论后路经关节突截骨术治疗强直性脊柱炎后凸畸形的临床效果满意，中短期随访临床效果良好。

Objective To review the middle and short term follow up result of the posterior transfacet osteotomy used in the treatment of Ankylosis Spondylitis Kyphosis Deformity. Methods We choose the 12 ankylosis spondylitis kyphosis deformity patients who were treated in our hospital from Dec, 2000 to Dec, 2006. There are 8 males, 4 females; the average age of these patients was 25.42 years old （18-32 years）. The location of the apex vertebral locates in the kypbosis deformities were as follows： there are 7 cases locate in the thoracic-lumbar region; another 5 patients locates in the lumbar spine areas. We choose to use the transfacet osteotomy approach to treat these patients, during the operation, multilevel osteotomy was performed. There are 2-4 levels were chosen to perform the osteotomy. We choose to collect the dates on the correction results, bone fusion conditions and complications during the follow up periods. Using the SPSS 15.0 to do the statistics＇ work, P〈 0.05 means the difference exists. Results There were no infection or die cases during the operation. There is one case found dura tears during the operation, and one patient the pedicular fracture in the planting of the pedicle screw, another case suffers from the trans-sensitive decreased in one leg. The average corrective Cobb anger was 25 degrees. The follow-up time was from 1.25-6 years, and 3.5 years for average. The corrective angle lost were 7.2 degrees, but all the patients have suffered from the bone fusion. Only one cases found the transpedicular screw fixation system was loosen. The Satisfaction Rates were 96.7%. Conclusion Posterior transfacet osteotomy was useful in treating the patients who suffers from the ankylosis spondylitis kyphosis deformity, the middle and short term follow up results suggests the good outcome.