经椎弓根截骨矫正强直性脊柱炎后凸畸形及疗效分析

Clinical results of transpedicular osteotomy for ankylosing spondylitic kyphosis and prospective outcome analysis

目的研究经椎弓根截骨矫正强直性脊柱炎后凸畸形的手术方法及其疗效。方法 2006年1月～2010年7月该科收治12例强直性脊柱炎后凸畸形患者,男性10例,女性2例,平均年龄37.5岁(24～58岁)。全部采取后路经椎弓根截骨矫形术,术前在纸样上模拟截骨,术前和术后测量颌眉角以及全脊柱侧位X片测量胸腰椎后凸角,统计术前术后VAS及ODI评分。结果患者术后视线角度改善明显,平均随访28个月,所有患者术区无假关节形成,患者矫正度无丢失,腰背痛等症状明显改善,平均颌眉角、矢状位平衡、Cobb角、VAS及ODI均改善明显(P<0.05)。结论采用术前模拟截骨确定截骨部位及角度,行后路经椎弓根截骨矫形术治疗强直性脊柱炎后凸畸形是一种较好的治疗方法。

【Objective】 To evaluate the clinical results of transpedicular osteotomy for ankylosing spondylitic kyphosis and the prospective outcome.【Methods】 We gave surgical treatment to 12 patients suffer from ankylosing spondylitic kyphosis from Jan 2006 to July 2010 in our department.There were 10 male and 2 female,the average age was 37.5 years.Before we took transpedicular osteotomy,preoperative and postoperative chin-brow vertical angle,sagittal Cobb angle of the vertebral osteotomy segment were documented along with the VSA and ODI scores,then a simulated osteotomy was performed on a paper plate.【Results】 The vision of patients changed greatly.Also,no cases of posterior pseudarthrosis were found in the region of the posterior lamina and all vertebra fused well without any losing of corrective rate after 28 months＇ follow-up（average）,and the symptom of lumbar pain was relieved too,the average chin-brow vertical angle,sagittal balance of spine,sagittal Cobb angle and VSA,ODI improved a lot（P〈 0.05）.【Conclusion】 Transpedicular posterior osteotomy was proved to be a good method to treat ankylosing spondylitic kyphosis with simulated osteotomy before surgery.