强直性脊柱炎胸腰椎后凸畸形患者生存质量与矢状面参数的相关性

Correlations of quality of life and sagittal parameters in ankylosing spondylitis with thoracolumbar kyphosis

目的 探讨强直性脊柱炎（ankylosing spondylitis,AS）胸腰椎后凸畸形患者生存质量与矢状面参数的相关性.方法 2011年6月至2013年8月,门诊AS患者30例、行经椎弓根椎体截骨矫形术的住院AS患者34例纳入研究.以SF-36量表评估患者生存质量;在站立位全脊柱X线侧位片上测量脊柱-骨盆矢状面参数;评估AS疾病活动性指数、AS功能指数和Oswestry下腰痛评分.依据胸腰椎最大后凸角将患者分为轻度后凸组（＜60°,29例）和重度后凸组（60°,35例）,比较两组患者的生存质量及矢状面参数,分析生存质量与矢状面参数的相关性.结果 重度后凸组患者在生理职能、一般健康状况、社会功能和情感职能四个维度的得分低于轻度后凸组.两组患者C7倾斜角、胸腰椎最大后凸角、矢状面躯干偏移、骨盆倾斜角、腰椎前凸角和骶骨倾斜角的差异有统计学意义.C7倾斜角和腰椎前凸角减小致生理职能评分减少;胸腰椎最大后凸角增加致情感职能评分降低;矢状面躯干偏移增大致社会功能评分减低.手术治疗患者随访6～36个月,平均16个月.末次随访时除胸椎后凸角和骨盆入射角外其他矢状面参数均较术前改善,一般健康状况、社会功能和情感职能评分均提高.结论 重度胸腰椎后凸畸形AS患者的生理职能、一般健康状况、社会功能和情感职能较轻度后凸患者降低.C7倾斜角、胸腰椎最大后凸角、腰椎前凸角和矢状面躯干偏移改变是AS患者生存质量降低的重要因素.经椎弓根椎体截骨术矫正胸腰椎后凸畸形矢状面参数的同时可提高患者生存质量.

Objective To investigate the correlations of quality of life and sagittal parameters in ankylosing spondylitis （AS） patients with thoracolumbar kyphosis.Methods From June 2011 to August 2013,64 AS patients were reviewed,including 30 outpatients and 34 inpatients underwent pedicle subtraction osteotomy （PSO）.Spino-pelvic parameters were measured on standing lateral full-spine radiographs,including cervical 7 tilt （C7T）,sagittal vertical axis （SVA）,global kyphosis （GK）,thoracic kyphosis （TK）,lumbar lordosis （LL）,pelvic incidence （PI）,sacral slope （SS）,and pelvic tilt （PT）.Simultaneously,the scores of Bath ankylosing spondylitis disease activity index （BASDAI）,Bath ankylosing spondylitis functional index （BASFI）,SF-36 questionnaire and the Oswestry disability index （ODI） were recorded.The subjects were divided in to mild kyphosis group （GK＜60°,n=29） and severe kyphosis group （GK≥60°,n=35）.The correlations were be analyzed between the quality of life and the sagittal parameters in AS patients.Multiple regression analysis was used to investigate the sagittal parameters which impaired the quality of life in AS patients.Results The scores of physical role,general health,social function,and emotional role were lower in severe kyphosis group when compared with mild kyphosis group.C7T,TK,GK,SVA,PT,LL,and SS were significant different in the two groups.Lower C7T and LL leaded to the score of physical role decreased; high GK resulted in the low score of emotional role; large SVA diminished the score of social function of AS patients.For AS patients underwent PSO with a mean follow-up of 16 months （range,6-36 months）,all the parameters were significantly improved,except for PI and TK,and the scores of general health,social functioning,and role emotional were significant increase at the last follow-up.Conclusion The quality of life in physical role,general health,social function and emotional role were significantly decreased in severe kyphosis group,and C7T,LL,GK,and SVA were the most important factors impaired the quality of life in AS patients.The quality of life can be improved by correcting the sagittal parameters in AS patients with thoracolumbar kyphosis.