强直性脊柱炎后凸畸形个性化矫形对术后生活质量影响的相关分析

An analylsis on the quality of life after personalized kyphosis correction in ankylosing spondylitis

目的对强直性脊柱炎(ankylosing spondylitis,AS)后凸畸形个性化矫形后生活质量评分的进行相关性研究。方法 2007年1月至2011年11月,共有40例无脊髓神经症状体征、双髋活动良好的AS后凸畸形患者纳入本研究,采用随机数字表法将40例患者分为A、B两组,均行后路经椎弓根单节段或双节段楔形闭合截骨矫形椎弓根螺钉内固定术,A组采用个性化截骨方案,B组采用传统截骨方案。记录AS患者矫形前后骨盆入射角(pelvic incidence,PI),骨盆倾斜角(pelvic tilt,PT),术前及术后6个月脊柱侧凸研究学会(scoliosis research society,SRS)-22评分、Oswestry功能障碍指数(oswestry disability index,ODI)。分析矫形前后主观评分变化及矫形后PI、PT变量关系。结果 A、B两组术前PI、PT值、ODI指数及SRS-22评分相比差异无统计学意义(P>0.01),术后A、B两组患者外观、心理、疼痛、功能及满意度均趋于正常,且ODI指数较术前明显改善,A、B两组术后SRS-外观评分分别为(4.6±0.3)、(4.3±0.3),差异有统计学意义(P<0.01),SRS-心理、疼痛、功能、满意度差异无统计学意义(P>0.01),A、B两组术后ODI指数差异无统计学意义(P>0.01)。结论个性化矫形对AS患者术后生活质量有着较好的改善,同时,对颌眉角的纠正也具有更好的可控性。熟练掌握个性化矫形方法后,可以明显简化手术方案的讨论与争议,并能达到与传统截骨方案相似甚至更好的效果。

Objective To investigate health-related quality of life（ HRQOL） after personalized kyphosis correction in ankylosing spondylitis（ AS）. Methods Forty AS patients with fixed thoracolumbar kyphosis were treated with pedicle subtraction osteotomies（ PSO） in our hospital from January 2007 to November 2011. All patients with no spinal cord neurological signs and good hip range of motion in both sides were divided into two groups under randomized method. Closing wedge osteotomy correction and pedical screw fixation of single segment or double segments from posterior approach were performed in both groups. Group A was treated with personalized PSO and group B was treated with traditional PSO. Pre- and post-operative pelvic incidence（ PI）, pelvic tilt（ PT） were measured. The scoliosis research society-22（ SRS-22） questionnaire and Oswestry disability index（ ODI） were used to evaluate clinical results. Analyses of assessing scores and the relationship between PI and PT preoperatively and postoperatively were conducted. Results There were no significant differences between group A and group B in preoperative PI, PT, ODI and SRS-22（ P〉0.01）. All of the patients experienced improvement in appearance, psychology, pain, function and satisfaction, especially ODI. There were no significant differences between A and B in post-operative ODI, SRS-psychology, pain, function and satisfaction（ P〉0.01） but SRS-appearance（ P=0.0020）, which were（ 4.6±0.3）,（ 4.3±0.3） respectively. Conclusions Personalized kyphosis correction can improve the quality of life for AS patients after the operation. It also has better controllability on the correct angle of the chin-brow. Mastering of the personalized method can significantly simplify discussions and controversies of the operation plan to achieve similar even better effects compared with traditional method.