后路经椎弓根闭合性楔形截骨治疗强直性脊柱炎所致脊柱后凸畸形

Transpedicular closed wedge osteotomy for kyphosis in ankylosing spondylitis

[目的]探讨后路经椎弓根闭合性楔形截骨治疗强直性脊柱炎所致脊柱后凸畸形的临床疗效。[方法]2004年6月～2009年6月,对27例强直性脊柱炎所致后凸畸形患者,行后路经椎弓根闭合性楔形截骨术。通过术前、术后及随访时矢状面X线片,测量腰椎前凸角、胸椎后凸角及C7铅线与S1后上角距离,术前、术后大体像颌眉角的大小,评价患者的矫形效果。[结果]27例患者均获随访,随访时间2年～6年3个月,平均3年7个月。术中3例出现硬脊膜破裂,2例椎弓根螺钉拔出,术后4例出现脑积液漏,2例切口浅表感染,2例出现神经根受损症状。腰椎前凸角术前平均-4°,术后平均29°,胸椎后凸角术前平均62°,术后平均49°,C7铅线与S1后上角距离术前平均197 mm,术后平均41 mm。颌眉角由术前平均49°至术后平均4°。患者矢状面平衡得到恢复,能够平视行走。[结论]采用后路经椎弓根闭合性楔形截骨术治疗强直性脊柱炎所致脊柱后凸畸形较安全,可获得良好的矫形效果。

[Objective] To evaluate the effect of transpedicular closed wedge osteotomy for kyphosis in ankylosing spondy- litis. [ Methods] From June 2004 to June 2009, a consecutive series of 27 ankylosing spondylitis patients with kyphosis were managed by posterior transpedicular closed wedge osteotomy. The sagittal angles and sagittal balance were analyzed to determine the corrective effect of kyphosis by measuring the data from the standing lateral plain films, which were taken before and after the operation, and at the follow - up respectively. The chin brow vertical angle were also measured from photographs of the patients before and after operation. [ Results] The average time of follow - up were 3 years and 7 months （ range, from 2 years to 6 years and 3 months） . Intraoperative, three patients had dural rupture, two cases occurred pedicle screw pull out. Postopera- tively, four dura tears, two superficial wound infections and two neurological deficits were found. Lumbar lordosis before surgery averaged -4~and improved to 29°. Thoracic kyphosis corrected from 62°to 49°. The sagittal vertical axis measured from C7 S1 demonstrated a preoperative sagittal decompensation averaging 197 mm with correction to 41 mm. The chin brow vertical angle was corrected from 49°to 4°on average. The sagittal balance were significantly improved postoperatively, and all patients were al- be to walk in horizontal gaze. [ Conclusion ] Transpedicular closed wedge osteotomy has a good effectiveness for patients with ankylosing spondylitis kyphosis, it is a safe and reliable technique to correct rigid kyphosis and provide biomechanical stability.