摘要
目的 :比较单节段脊柱去松质骨截骨(vertebral column decancellation,VCD)与双节段经椎弓根截骨(pedicle subtraction osteotomy,PSO)矫正强直性脊柱炎后凸畸形的临床效果,探索两者之间的差异性。方法 :2007年1月~2013年3月共有33例需行40°~65°截骨的强直性脊柱炎后凸畸形矫形术后患者纳入研究,其中男31例,女2例,年龄19~56岁(35.2±8.9岁),后凸畸形以胸腰段后凸为重,脊柱胸腰段后凸Cobb角42.3°±15.2°,腰段前凸Cobb角4.4°±16.4°。A组15例行单节段VCD,B组18例行双节段PSO,记录手术前后胸椎后凸角、胸腰段后凸角、腰椎前凸角、矢状面垂直轴、骨盆入射角、骨盆倾斜角、骶骨倾斜角、截骨角度、脊柱侧凸研究学会(Scoliosis Research Society,SRS)-22量表评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、术中出血量及手术时间,比较两组观察指标及其变化量之间的差异。结果 :A组截骨部位分别为T12 1例、L2 6例、L3 8例,截骨角度46.7°~64.2°(53.6°±6.7°);B组截骨部位分别为L1、L3 13例,T12、L2 4例,T12、L3 1例,截骨角度45.1°~63.9°(55.6°±6.0°)。固定节段于截骨部位近端及其远端延伸至少2个椎体,B组截骨部位之间椎体均固定。A、B两组患者术后均未出现神经系统并发症。A、B两组术后胸腰段后凸角、腰椎前凸角、骶骨倾斜角、骨盆倾斜角、矢状面垂直轴、ODI、SRS-功能评分、SRS-疼痛评分、SRS-外观评分、SRS-心理评分、SRS-满意度评分均较术前明显改善(P〈0.05),A组术后胸椎后凸角与术前相比差异无统计学意义(P〉0.05),B组术后胸椎后凸角与术前相比变小且差异有统计学意义(P〈0.05)。两组观察指标对比,除胸椎后凸角变化量、术中出血量和手术时间两组间有统计学差异(P〈0.05)外,余均无统计学差异(P〉0.05)。结论:对于需行40°~65°截骨角度的强直性脊柱炎后凸畸形患者,单节段VCD可取得与双节段PSO相似的矫正效果,且术中出血量更少,手术时间更短,在重建矢状面平衡与改善生活质量方面效果满意。
Objectives: To investigate the surgical outcome differences of ankylosing spondylitis(AS)-related kyphosis between one-level vertebral column decancellation and two-level pedicle subtraction osteotomy.Methods: From January 2007 to March 2013, 33 patients(31 males and 2 females) with an osteotomy angle between 40° and 65°, and with an average age of 35.2 years(19-56 years) were reviewed. The thoracolumbar kyphosis angle was 42.3°±15.2° and the lumbar lordosis angle was 4.4°±16.4°. Group A included 15 cases who underwent one-level vertebral column decancellation, and group B included 18 cases who underwent two-level pedicle subtraction osteotomy. The thoracic kyphosis, thoracolumbar kyphosis, lumbar lordosis, sagit-tal vertical axis, pelvic incidence, pelvic tilt, sacral slope, osteotomy angle, Scoliosis Research Society(SRS)-22 and Oswestry disability index(ODI) score at the pre- and post-operation were recorded between 2 groups. The observational indexes before and after surgery as well as the differences of the observational index variation between group A and group B were compared, respectively. Results: The osteotomy sites of group A included 1in T12, 6 in L2 and 8 in L3, respectively. Osteotomy angle ranged from 46.7° to 64.2°(53.6°±6.7°). The osteotomy sites of group B included 13 in L1 and L3 respectively; 4 in T12, L2 and 1 in T12 and L3 each.Osteotomy angle ranged from 45.1° to 63.9°(55.6°±6.0°). The fixed segment in the proximal and distal segments extended at least two vertebral bodies, the vertebral body between osteotomy sites in group B must be fixed.The neurological complication was not noted in 2 groups after operation. The thoracic kyphosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, pelvic tilt, sacral slope, SRS-22 and ODI of two groups improved significantly(P〈0.05) after operation except of the thoracic kyphosis of group A(P〉0.05). The differences of observational index variation between group A and group B showed no statistical significance(P〉0.05) except of the changes of thoracic kyphosis, peri-operative bleeding and operation time(P〈0.05). Conclusions: One-level vertebral column decancellation and two-level pedicle subtraction osteotomy have similar outcomes for AS patients with the osteotomy angle between 40° and 65°. While for sagittal balance and improvement of the quality of life, one-level vertebral column decancellation is more satisfactory.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2015年第9期775-780,共6页
Chinese Journal of Spine and Spinal Cord
关键词
强直性脊柱炎
单节段脊柱去松质骨截骨
双节段经椎弓根截骨
对比分析
Ankylosing spondylitis
One-level vertebral column decancellation
Two-level pedicle subtraction osteotomy
Comparative analysis