脊柱矢状面畸形截骨角度计算方法的研究进展

Calculation of the angle required during pedicle subtraction osteotomy for fixed sagittal deformity： a literature review

脊柱矢状面畸形是导致躯体矢状面失衡的常见原因之一。躯体失衡可引起躯干前倾、心肺功能异常、平背综合征、顽固性腰痛等一系列情况，影响患者的生活质量，对社会经济带来巨大负担。脊柱矢状面畸形的治疗一直是临床脊柱矫形领域的热点，其治疗主要目的在于重建躯体矢状面的总体平衡，缓解相应症状、提高生活质量。后路经椎弓根椎体截骨术（pediclesubtractionosteotomy，PSO）凭借其优良的重建矢状面平衡的特点被认为是最为安全有效的脊柱矫形术之一。然而，患者术中截骨角度的计算至今仍是难题，截骨角度过大、过小均将引起术后躯体矢状面的二次失衡。因此，术前截骨角度的准确计算显得尤为重要。近年来，国内外学者通过对躯干矢状面平衡机制的深人研究，认为躯干矢状面平衡主要由脊柱矢状面排列、骨盆矢状面排列和下肢矢状面排列三个部分组成，并分析了三者各自平衡及相互之间排列关系对维持躯体矢状面平衡的意义。研究者们通过各自的研究制定了躯体术后矢状面平衡标准，并基于躯体平衡机制提出了多种截骨角度的定量分析方法，包括：三角法、精确角度计算法、躯干整体平衡法、脊柱股骨角测量法、数字虚拟法、图解法、外耳道-髋轴测量法和肺门-髋轴测量法。这些截骨角度方法为患者脊柱矢状面畸形的治疗提供了重要理论依据。

Sagittalspinaldeformity is one of the common reasons of sagittal disequilibrium which can cause torso forward, cardiopulmonary dysfunction, flat back syndrome, intractable low back pain and a series of cases, affecting the patients＇ life quali- ty and increasing huge economic burden on society. The treatment of sagittal spinal deformity has been a hot spot in the field of clinical spinal surgery and its main purpose is to reconstruct the overall balance of the body, which would relieve pain and improve life quality. Pedicle subtraction osteotomy is considered to be one of the most effective and safe method for correcting spinal defor- mity with excellent reconstruction of sagittal plane balance. However, the calculation of the angle required during surgery is still a problem, because insufficient or excessive correction will lead to the secondary sagittal disequilibrium. Therefore, an accurate cal- culation of the angle required during pedicle subtraction osteotomy is particularly important. In recent years, scholars believe that the sagittal equilibrium depends on a fragile balance among spinal curvature, pelvic shape and position of the lower limbs. Schol- ars have developed a standard of sagittal equilibrium based on their own research, and proposed a variety of quantitative analysis methods to calculate the angle required during pedicle subtraction osteotomy： trigonometric method, exact angle calculation meth- od, overall balance method, spine femoral angle measurement method, digital virtual method, graphic method, acoustic meati to hip axis method and hilus pulmonis to hip axis method, which provide important theoretical bases for the treatment of sagittal spi- nal deformity.