强直性脊柱炎后凸畸形矫形前后生活质量与影像学参数分析

Analysis on correlation of radiographic parameters and quality of life before and after kyphosis correction in ankylusing spondylitis

目的进行强直性脊柱炎（ankylosing spondylitis，AS）僵硬性胸腰段后凸畸形矫形前后影像学参数与主观评分的相关性研究。方法2004年1月至2010年3月，对收治的38例无脊髓神经症状与体征、双髋活动良好的AS僵硬性胸腰段后凸畸形患者，行后路单节段或双节段经椎弓根截骨矫形椎弓根螺钉内固定术。男24例，女14例；年龄22-57岁，平均35岁。测量AS患者矫形前后身高、颌眉角、屈膝角、全脊柱后凸角（CobbT1-S1）、骨盆入射角（pelvicincidence，PI）、骨盆倾斜角（pelvictitle，Prr）、骶骨倾斜角（sacralslope，SS）、矢状面平衡距离（sagittalverticalaxis，SVA），记录患者矫形前后Oswestry功能障碍指数（Oswestrydisabilityindex，ODI）、脊柱侧凸研究会-22项问卷（scoliosisresearchsociety-22，SRS-22）评分。分析矫形前后外观、影像学参数及主观评分变化；控制影响患者个体差异的因素，将影像学参数及主观评分行偏相关分析。结果患者矫形后外观、生存质量、活动能力、心理状态趋于正常；CobbT1-S1、SVA及骨盆位置性参数（PT、SS）显著改善。矫形前CobbT1-S1、PT、SS、SVA与ODI行走、站立分项呈偏相关。矫形后门、SS与ODI总分、行走、站立呈偏相关，但CobbT1-S1、SVA与ODI总分、行走、站立不呈偏相关。结论骨盆后旋状态导致AS后凸畸形患者直立活动能力下降，确保骨盆中立位是矢状面平衡重建的最终目标。

Objective To investigate the correlation of radiographic parameters and health-related quality of life （HRQOL） instruments before and after thoracolumbar kyphosis correction in ankylosing spondylitis （AS） kyphosis. Methods Thirty-eight AS patients with fixed thoracolumbar kyphosis were treated with pedicle subtraction osteotomies （PSO） in our hospital from January 2004 to March 2010. Pre- and post-operative radioiogical parameters, Cobb T1-S1, pelvic incidence （PI）, pelvic tilt （PT）, sacral slope （SS）, and sagittal vertical axis （SVA） were measured. The Oswestry disability index （ODI） and scoliosis research society-22 （SRS-22） questionnaire were used to evaluate the clinical results. Statistical correlation analysis was made to determine correlation between radiographic parameters and overall or partial specific scores of HRQOL instruments. Results The life quality and related radiological spino-pelvie parameters were im- proved significantly after operation. Preoperatively, Cobb T1-S1, PT, SS, and SVA had partial correlation with ODI walking score and ODI standing score; postoperatively, only PT and SS had partial correlation with ODI. Conclusion Pelvic positional parameters are the key parameters for upright activities, and making pelvis in a neutral position is the ultimate goal of surgery.