截骨术矫治强直性脊柱炎胸腰段后凸畸形19例观察

Single-Segment Transpedicular Vertebral Osteotomy on the Top of Kyphosis Combined with Screw Internal Fixation for Correction of Thoracolumbar Spine Kyphosis in Ankylosing Spondylitis

目的:评价经T12或L1单节段经椎弓根椎体截骨术治疗强直性脊柱炎胸腰交界段后凸畸形的临床疗效。方法:对19例后凸畸形位于胸腰交界段的静止期强直性脊柱炎患者,经后路行T12或L1单节段经椎弓根椎体截骨钉-棒系统内固定术。手术前后测量胸腰交界段Cobb’S角(T11～L2)、颌眉垂线角及身高,比较手术前后差异。结果:19例患者均顺利完成手术,患者胸腰交界段Cobb’S角由术前46.4±16.9°减小至-6.3±14.7°,颌眉垂线角由术前60.5±13.4°减小至13.8±4.3°,身高由术前137.8±11.2 cm增加至158.2±7.4 cm,以上项目手术前后比较均有显著性差异(P<0.05)。术后患者重心前移、双目平视、脊柱矢状面失平衡得到明显的改善。结论:运用经T12或L1单节段椎弓根椎体截骨内固定术可以有效矫正胸腰交界段的强直性脊柱炎脊柱后凸畸形,纠正脊柱矢状面失平衡,恢复患者平视。

Objective：To evaluate the outcome of transpedicular vertebral osteotomy on T12 or L1 for correction of thoracolumbar spine kyphosis in ankylosing spondylitis. Methods：19 patients of thoracolumbar spine kyphosis with ankylosing spondylitis were treated with single-segment transpedicular vertebral osteotomy on T12 or L1 and screw internal fixation.Compared the difference by measuring the preoperative and postoperative Cobb＇S angle from T11 to L2、chin-brow vertical angle and height. Results：The operations of 19 patients were successfully completed,the Cobb＇s angle from T11 to L2 decreased from 46.4±16.9°to-6.3±14.7°,the chin-brow vertical angle decreased from 60.5±13.4° to 13.8±4.3°,the height increased from 137.8±11.2 cm to 158.2±7.4 cm,all patients could walk with forward vision and the loss of spinal sagittal balance were improved significantly. Conclusion：single-segment transpedicular vertebral osteotomy on T12 or L1 combined with screw internal fixation is a safe and effective method for correction of thoracolumbar spine kyphosis with ankylosing spondylitis.