经椎弓根及椎间盘截骨治疗强直性脊柱炎合并Andersson骨折

Transpedicular and intervertebral disc osteotomy for ankylosing spondylitis complicated with Andersson fractures

目的探索经椎弓根及椎间盘截骨治疗强直性脊柱炎合并Andersson骨折的疗效及可行性。方法 2009年1月—2013年1月,采用经椎弓根及椎间盘截骨术治疗强直性脊柱炎合并Andersson骨折患者17例,所有患者随访>2年。其中男12例,女5例;平均48.7岁;其中9例有明确外伤史,8例无外伤史;9例患者出现渐进性胸腰段脊柱后凸畸形;8例无明显畸形。根据美国脊髓损伤协会(ASIA)评分评估神经损伤等级(E级11例,D级4例,C级2例)。收集所有患者术前及术后X线和CT资料,测量整体后凸角度,局部后凸角度及矢状面平衡。记录患者术前和术后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。结果所有手术顺利完成,平均手术时间为219 min,术中平均出血量为876 m L。ASIA D级4例恢复到E级;C级1例恢复至E级,1例恢复至D级。术前平均局部后凸从29.1°降低至随访时的5.9°;术前平均整体后凸从59.1°降低至随访时的24.7°。平均矢状面平衡从术前153.7 mm改善至随访时的41.1 mm。平均腰痛VAS评分从术前6.4分下降到随访时的1.1分,平均ODI由术前50.9%改善至随访时的16.9%。所有患者皆获得骨性融合。结论经椎弓根及椎间盘截骨技术可获得满意的矫形效果及良好的融合,是治疗强直性脊柱炎合并Andersson骨折的有效方法。

Objective To explore the efficacy and feasibility of transpedicular and intervertebral disc osteotomy for ankylosing spondylitis（AS） complicated with Andersson fractures. Methods Data of 17 consecutive patients suffering AS complicated with Andersson fractures treated by transpedicular and intervertebral disc osteotomy from January 2009 to January 2013 were analyzed retrospectively. All the patients completed follow-up of at least 2 years. There were 12 males and 5 females,with average age of 48.7 years. Andersson lesion developed after a trauma in 9 patients,and 9 patients complained of progressive thoracolumbar kyphosis. According to American Spinal Injury Association（ASIA） grading system,11 patients were graded as grade E,4 grade D,2 grade C. Radiographic and CT examination data were collected from all the patients before and after surgery,and global angle,regional angle and sagittal vertical axis（SVA） were measured. Clinical outcome data including visual analogue scale（VAS） score and Oswestry Disability Index（ODI） were collected. Results All surgeries were performed successfully. The mean surgical time was 219 min with a mean intraoperative blood loss of 876 m L. Four grade D patients recovered to grade E;in 2 grade C cases,one recovered to grade E,and the other one recovered to grade D. The preoperative mean regional angle was reduced from 29.1° to 5.9° and the preoperative mean global angle was reduced from 59.1° to 24.7° at the time of follow-up. The preoperative mean SVA was reduced from 153.7 mm to 41.1 mm,the preoperative mean back pain VAS score from 6.4 to 1.1 and the preoperative mean ODI from 50.9% to 16.9% at the time of follow-up. Solid fusion was obtained in all the patients. Conclusion Transpedicular and intervertebral disc osteotomy can achieve satisfactory kyphosis correction,good fusion and favorable clinical outcomes,implying an alternative method for AS complicated with Andersson fracture.