强直性脊柱炎患者术后骨盆倾斜角与骶骨倾斜角比值与生活质量的相关性

Correlations between quality of life and sagittal parameters in ankylosing spondylitis after kyphosis correction

目的探讨骨盆倾斜角（pelvictilt，PT）与骶骨倾斜角（sacralslope，SS）比值对强直性脊柱炎患者后凸畸形矫形术后生活质量的影响。方法回顾性分析2008年11月至2011年5月手术治疗33例强直性脊柱炎后凸畸形患者资料，男31例，女2例；年龄19-58岁，平均36岁。其中后凸畸形以胸腰段后凸为主，胸腰段后凸Cobb角35．23°±13．98°（范围，15．12°-74．37°），腰段前凸Cobb角8．68°±18．27°（范围，-23．70°-62．15°）。以脊柱侧凸研究学会（Seoliosis Research Societv，SRS）-22评估患者生活质量，以Oswestry功能障碍指数（Oswestry disabilityindex，ODI）评估患者姿势性疼痛情况。在侧位X线片上测量矢状面参数，包括骨盆入射角（pelvicincidence，PI）、PT、SS、矢状面垂直轴（sagittal verticalaxis，SVA）及截骨角度，比较手术前后患者的矢状面参数与主观评分，并分析矢状面参数与主观评分的相关性.结果截骨部位分别为L．5例，截骨角度21．00°-54．59°，平均32．59°-13．44°；L219例，截骨角度28．63°-66．24°，平均37．89°±9．26°；L39例，截骨角度31．78°-60．90°，平均47．05°±9．20°；总体截骨角度21．00°-66．24°，平均39．59°±10．82°。手术前后骨盆参数及主观评分除骨盆入射角外差异均有统计学意义，术前PT／SS比值（4．33±3．65）与患者主观评分无相关性，术后1年PT／SS比值（0．93±0．65）与术后ODI站立评分[（0．60±0．75）分]呈显著正相关（r=0．681，P〈0．05），与其他项无相关性。截骨角度（39．59°±10．82°）与SRS-22治疗满意度评分变化量[（3．33±0．49）分]呈显著正相关（r=0．478，P〈0．05）。SVA、PT和Ss手术前后变化值与主观评分手术前后变化值无相关性。结论在强直性脊柱炎后凸畸形矫形术中，PT、SS、SVA的变化对比PT／SS比值的变化，后者与术后生活质量更加密切相关，这一点应当被临床医生在手术方案设计时所重视。

Objective To explore the impact of the ratio between pelvic tilt （PT） and sacral slope （SS） on the life quality of patients with ankylosing spndylitis （AS） after kyphosis correction. Methods From November 2008 to May 2011, 33 AS patients were reviewed, including 31 males and 2 females, aged from 19 to 58 years old （average, 36 years old）. The thoraeolumbar kypbosis angle was 35.23°± 13.98° （range, 15.12°-74.37°） and the lumbar lordosis angle was 8.68°± 18.27° （range,-23.70°- 62.15°）. The Scoliosis Research Society （SRS）-22 questionnaire was used to evaluate the quality of life and the Oswestry disability index （ODI） was used to evaluate the condition of pain. The pelvic incidence （PI）, PT, SS, sagittal vertical axis （SVA） and osteoto- my angle were obtained from standing lateral full-spine radiographs. The correlations were analyzed from the subjective grading and the sagittal parameters in AS patients. Results The osteotomy site was in Lt （5 cases, 21.00°-54.59°, average 32.59°± 13.44°）, L2 （19 cases, 28.630-66.24°, average 37.89°±9.26°）, L3 （9 cases, 31.78°-60.90°, average 47.05°±9.20°）, respectively. The range of osteotomy angle was 39.59°± 10.82° （range, 21.00°-66.24°）. The subjective grading and spino-pelvic parameters were improved significantly after operation except PI, only postoperative PT/SS （0.93±0.65） and ODI standing （0.60±0.75）（r=0.681, P〈 0.05）, osteotomy angle （39.59°± 10.82°） and satisfaction of management （3.33±0.49）（r=0.478, P〈 0.05） had correlation with the subjective grading. Conclusion Compared with the change of PT, SS and SVA, the change of PT/SS is more closely related to the quality of life after operation in AS patients with kyphosis, which should be pay attention to by surgeon when designing operative schemes.