蛋壳技术在强直性脊柱炎并脊柱后凸畸形矫形中的应用

Application of eggshell technique in the management of kyphotic deformity in ankylosing spondylitis

[目的]观察腰椎后路经椎弓根椎体楔形截骨的蛋壳技术在治疗强直性脊柱炎后凸畸形中的临床效果。[方法]34例强直性脊柱炎后凸畸形患者,平均年龄为34.6岁,男性27例,女性7例。根据术前测量的颌眉垂线角,采用后路经L2或L2及L3椎弓根的椎体楔形截骨。[结果]所有患者都能很好的耐受手术。手术时间为150～210min,出血量为1 000～2 400 ml。无神经系统并发症发生。颌眉垂线角由术前的平均41°矫正为术后的平均为5°。所有患者能够平视行走,矢状面平衡和步态得到明显改善。随访中植骨均获骨性融合,无断钉及内固定失效发生。[结论]腰椎后路经椎弓根的蛋壳技术,能够在充分保护脊髓和神经根的前提下实现椎体的楔形截骨,对于强直性脊柱炎后凸畸形具有良好的治疗效果。

[Objective]To assess the clinical results of transpedicular lumbar wedge resection osteotomy（eggshell technique） for correction of kyphotic deformity in ankylosing spondylitis.[Methods]Thirty-four patients of ankylosing spondylitis kyphotic deformity with mean age 34.6 years old received surgical treatment.There were 27 men and 7 women.The transpedicular wedge resection osteotomy was performed through L2 or L2 and L3 vertebrae according to the preoperative Chin-brow vertical angle.[Results]All the patients stood surgery well.The operative time were 150~210 min and the blood bleeding during operation were 1 000~2 400 ml.There was no postoperative neurologic complication and no breakage of nails or failure of the internal fixation during the follow up period.The mean Chin-brow vertical angle was corrected from preoperative 41°to postoperative 5°.All patients can walk with forward vision and sagittal balance and the gait was improved significantly.[Conclusion]Posterior transpedicular lumbar wedge resection osteotomy（eggshell technique） is effective for managing kyphosis in ankylosing spondylitis.It can provide good protection for spinal cord and nerve roots.