长节段椎弓根钉系统内固定与个性化截骨方法治疗强直性脊柱炎后凸畸形

Long-segment pedicle screw fixation and individual osteotomy in the treatment of ankylosing spondylitis with kyphosis

背景:生物力学的观点认为:强直性脊柱炎的矫形在后凸的顶点处截骨最佳,但术中脊髓损伤的风险大。目的:分析联合应用椎板间截骨+椎体截骨+长节段椎弓根钉系统内固定治疗强直性脊柱炎后凸畸形的临床效果。方法:强直性脊柱炎患者共36例,均采用PSO(Pedicle Subtraction Osteotomy)截骨+SPO(Smith-Peterson Osteotomy)联合截骨治疗。随访时间3个月至2年。结果与结论:36例患者未发现植入物修复后矢状位失平衡者,矢状位失衡的改善率为64%。患者植入物修复后胸腰椎后凸角的到恢复,改善率为60%;颌眉角的改善率为98%,疼痛症状缓解程度为64%,ODI指数95%;均未发生拔钉、断钉、断棒现象。说明选择性截骨矫形技术+长节段内固定手术能够获得稳定的内固定疗效,防止出现矢状位失平衡,以及强直性脊柱炎因骨质疏松导致的拔钉、断钉、断棒现象的发生。

BACKGROUND：Orthopedic osteotomy at the apex of kyphosis is best for treatment of ankylosing spondylitis from a biomechanical aspect, but there is a high risk for intraoperative spinal cord injury.OBJECTIVE：To explore the clinical efficacy of vertebral plate osteotomy＋vertebra osteotomy＋long-segment pedicle screw fixation in the treatment of ankylosing spondylitis with kyphotic deformity. METHODS：Thirty-six patients with ankylosing spondylitis were subjected to pedicle subtraction osteotomy and Smith-Peterson osteotomy, and then fol owed up for 3 months to 2 years. RESULTS AND CONCLUSION：After implantation, sagittal imbalance did not occur in 36 patients, and the improvement rate of sagittal imbalance was 64%. The improvement rates of thoracolumbar kyphosis and chin-brow vertical angle were 60%and 98%, respectively. The pain relief rate was 64%, and the Oswestry Disability Index was 95%. There were no pul ed nails, broken nails and broken robs after implantation. These findings indicate that the combination of selective osteotomy technique and long-segment internal fixation can achieve stable fixation effects, prevent sagittal imbalance, and avoid the occurrence of pul ing nails, breaking nails and breaking robs caused by osteoporosis.