强直性脊柱炎后凸畸形患者截骨矫形后腹部变化及消化功能的改变

Improvement of abdomen and digestive function in patients with ankylosing spondylitis kyphosis following pedicle subtraction osteotomy

目的 ：探讨强直性脊柱炎（AS）后凸畸形患者截骨矫形术后腹部变化及消化功能的改变。方法：2009年1月~2013年7月在我院行截骨矫形术的AS后凸畸形患者53例,其中男48例,女5例。均采用经椎弓根椎体截骨术（pedicle subtraction osteotomy,PSO）治疗,截骨节段为L1~L3。在术前及术后18个月的站立位全脊柱正侧位X线片上测量脊柱最大后凸Cobb角（GK）,在全脊柱三维CT重建图像上测量正中矢状面腹部面积（AMSPA）、正中矢状面剑突到脊柱前缘的最短距离（MD）及肝门、两侧肾门、脾门到耻骨联合上缘中点的距离。记录术前、术后18个月体重、ODI及脊柱侧凸研究学会-22（SRS-22）量表评分。术后18个月对患者消化功能进行评估,食量增加不明显为A组,食量明显增加为B组;大便频率无明显改变（3~4天1次）为1组,大便频率改善明显（1~2天1次）为2组。结果：术后18个月53例患者ODI及SRS-22量表评分较术前改善明显（P〈0.05）,GK较术前明显变小（P〈0.05）,MD、AMSPA和体重较术前明显增大（P〈0.05）,肝门、脾门、左侧肾门到耻骨联合上缘中点的距离均较术前明显增大（P〈0.05）,右侧肾门到耻骨联合上缘中点的距离较术前差异无统计学意义（P〉0.05）。术后18个月29例患者大便频率较术前有所增加,24例改善不明显;33例食量较术前明显增加,20例食量增加不明显。术后18个月1组与2组患者的年龄及病程均无明显差异（P〉0.05）,A组与B组的年龄、病程均无明显差异（P〉0.05）,1组GK明显大于2组（P〈0.05）,A组GK明显大于B组（P〈0.05）。结论：对AS后凸畸形患者,通过截骨矫形手术可以缓解脊柱屈曲对脏器的挤压、改善受挤压脏器的位置;术后患者消化功能得到明显的改善。

Objectives： To investigate the improvement of abdomen and digestive function in patients with ankylosing spondylitis kyphosis following pedicle subtraction osteotomy. Methods： From January 2009 to July2013, 53 patients in our department with severe ankylosing spondylitis kyphosis and undergoing pedicle sub-traction osteotomy were studied, there were 48 males and 5 females. All the patients underwent pedicle sub-traction osteotomy（PSO）, the segment of osteotomy was L1-L3. The globe kyphosis（GK） was measured in the whole spine X-ray photo preoperatively and at 18 months after surgery. Three- dimensional reconstruction was performed on all patients. The average of abdominal median sagittal plane（AMSPA） and the minimum distance（MD） between xiphoid process and spine or between abdominal wall and spine when the abdominal wall was folded into abdomen were measured on the three-dimensional computed tomography（3D-CT） scans. A health related quality of life including Oswestry Disability Index and Scoliosis Research Society outcomes instrument-22 and weight were recorded preoperatively and at 18 months after surgery. Digestive function assessment in-cluded the food intake（FI）, and the change of defecate frequency was recorded at 18 months after surgery, the patients were divided into group A（no change） and group B（obviously increased according to intake changes）,and group 1（no change） and group 2（significantly increased according to the defecate frequency changes）.Results： Obvious improvement in ODI, weight and SRS-22 in all the patients at 18 months after surgery（P〈0.05） was noted. The GK decreased significantly at 18 months after surgery（P〈0.05）. MD and AMSPA increased significantly compared with pre-operation（P〈0.05）. The distances from porta hepatic, hilum of spleen,left renal hilum to margo superior of symphysis pubis were longer compared with those of pre-operation（P〈0.05）. The distance between right renal hilus and mago superior of pubic symphysis showed no statistical significance compared with that of pre-operation（P〉0.05）. 29 patients showed significant improvement of defecate frequency at 18 months after surgery, however 20 patients showed no change（P〈0.05）. 33 patients showed significant improvement of food intake at 18 months after surgery, however 24 patients showed no change. There were no significant differences in terms of age, course of diseases between group A and group B（P〉0.05）. GK value of group A was significantly greater than that in group B, which was the same with group 1 and group2（P〈0.05）. Conclusions： The conditions of extrusion of viscus by trunk flexion and decreased volume of the abdominal cavity are improved in patients with ankylosing spondylitis kyphosis after osteotomy, followed by digestive function improvement.