脊柱后路去骨松质截骨术在强直性脊柱炎胸腰段后凸畸形矫正手术中的应用

Posterior of vertebral column decancellation for ankylosing spondylitis patients with rigid thoracolumbar kyphotic deformity

目的分析并评估脊柱后路去骨松质截骨矫形术(vertebral column decancellation,VCD)应用于矫正强直性脊柱炎胸腰段后凸畸形的安全性和有效性。方法回顾性分析2009年6月-2012年5月我院112例强直性脊柱炎胸腰段后凸畸形患者的临床资料,其中36例患者纳入研究。根据纽约标准影像学特征、实验室检查以及临床特征对强直性脊柱炎后凸畸形进行诊断。按照强直性脊柱炎后凸畸形分型,纳入研究的强直性脊柱炎胸腰段后凸畸形患者在胸腰段后凸区域行VCD单节段截骨。监测术中出血量,测量术前、术后矢状面Cobb角、矢状面偏移距离(sagittal vertical axis,SVA)、颏额垂线角(chin-brow vertical angle,CBVA),SRS-22调查表评估患者术前及术后6个月生活质量。结果所有接受脊柱后路去骨松质截骨后凸畸形矫正患者均顺利完成手术,围术期未发生截骨平面以下完全瘫痪等严重并发症,无患者死亡。术前矢状位Cobb角为45°(13°～60°)、矢状面偏移距离为22.4(14.3～29.5)cm、颏额垂线角为42°(25°～63°),术后1周测矢状位Cobb角为5°(0°～16°)、矢状面偏移距离7.9(2.6～12.5)cm、颏额垂线角10°(4°～17°),与术前比较差异有统计学意义(P<0.05),术前SRS-22量表评分中功能评分为2.42±0.54,外观评分为2.15±0.48,术后6个月SRS-22量表评分功能评分为4.25±0.48,外观评分为4.18±0.50,与术前比较差异有统计学意义(P<0.05)。结论单纯后路椎体去骨松质截骨术在强直性脊柱炎胸腰段后凸畸形矫正手术中可恢复脊柱矢状面平衡和稳定,同时可避免脊髓过度短缩、神经卡压等并发症,是一种较安全有效的截骨矫形方法。

Objective To introduce and evaluate the efficacy and safety of a new vertebral osteotomy method： vertebral column decancellation（VCD） for patients with rigid thoracolumbar kyphosis deformity secondary to ankylosing spondylitis（AS）.Methods From June 2009 to May 2012, 36 AS patients who underwent VCD for correction of thoracolumbar kyphosis were included in this retrospective study. The diagnosis of AS with rigid thoracolumbar kyphosis was made on the basis of radiographic features, laboratory tests, and clinical features according to New York standards. The technique of VCD was administrated at single osteotomy vertebrae in thoracolumbar region of AS kyphosis patients according to classification of AS kyphosis. Intraoperative bleeding and perioperative complications were recorded. Pre- and postoperative chin-brow vertical angle（CBVA）, sagittal vertical axis（SVA）, sagittal Cobb angle in thoracolumbar region were recorded and analyzed. Scoliosis Research Society-22（SRS-22） was used to evaluate the pre- and postoperative life quality of these patients. Results All surgeries were completed successfully and no major acute complications such as complete paralysis or death occurred. Compared with preoperative CBVA, SVA and thoracolumbar sagittal Cobb angle, postoperative CBVA, SVA and thoracolumbar sagittal Cobb angle improved significantly [45°（13°-60°） vs 10°（4°-17°）, 22.4（14.3-29.5） cm vs 7.9（2.6-12.5） cm, 42°（25°-63°） vs 5°（0°-16°）, P〈0.05]. Compared with preoperative, the SRS-22 score increased significantly at 6 months after operation [（2.42±0.54） vs（4.25±0.48）,（2.15±0.48） vs（4.18±0.50）, P 0.05]. Conclusion The technique of vertebral column decancellation（VCD） is a new, safe and effective option for correction of rigid thoracolumbar sagittal deformities caused by AS. In the meantime, VCD can avoid the complications such as excessive shortening and injury of spinal cord in the correction of deformity and sagittal imbalance.