经椎弓根双椎体截骨矫正重度强直性脊柱炎后凸畸形的可行性及其疗效分析

The feasibility and efficacy analysis of double vertebral osteotomy for correction of severe ankylosing spondylitis

目的探讨经椎弓根双椎体截骨矫正与单椎体截骨矫正治疗重度强直性脊柱炎(AS)后凸畸形的临床疗效。方法纳入2011-12-2015-12我院收治的重度AS后凸畸形患者42例,随机均分为2组:观察组21例接受经椎弓根双椎体截骨矫正治疗,术式采用经椎弓根闭合楔形截骨(PSO),对照组接受经椎弓根单椎体截骨矫正治疗,术式采用中柱闭合-前柱张开的改良PSO(COWO)。对比2组手术效果、矫正效果及围术期并发症情况。结果观察组手术时间明显长于对照组、术中出血量明显多于对照组,差异有统计学意义(P<0.05);2组脊柱后凸角、颌眉垂线角、C7铅垂线与骶骨后上角之间的垂线距离(SVA)矫正率接近,差异无统计学意义(P>0.05);观察组围术期并发症发生率明显低于对照组,差异有统计学意义(P<0.05)。结论对重度AS后凸畸形患者,行经椎弓根双椎体截骨矫正治疗能够达到与经椎弓根单椎体截骨矫正治疗相近的临床疗效,且能够有效减少围术期并发症,但其手术时间较长、术中出血量较多。

Objective To investigate the correction of double vertebral osteotomy through pedicle of vertebral arch and clinical effect of single vertebral osteotomy in the treatment of severe ankylosing spondylitis （AS）. Methods 42 patients with severe AS who admitted in our hospital from December 2011 to December 2015 were randomly divided into two groups. 21 cases in the observation group received transpedicular vertebral osteotomy for orthodontic treatment and operation using the pedicle closed wedge osteotomy bone （PSO）. The control group received the pedicle subtration osteotomy and orthodontic treatment, used column closed-Pre column open modified PSO COWO. The operation effect, correction effect and perioperative complications＇were compared between the two groups. Results In the observation group, the operation time was significantly longer than the control group, intraoperatire bleeding volume was significantly larger than that in the control group, the differences were statistically significant （P〈0.05）. The spine angle, chin brow vertical angle, C7 plumb line and the posterior sacral angle between the vertical distance （SVA） correction rate in two groups were similar, the differences were not statistically significant （P〉0.05）. The incidence rate of complications in observation group was significantly lower than that in the control group, the difference was statistically significant （P〈0.05）. Conclusion Transpedicular vertebral osteotomy for correction of severe AS kyphosis has similar clinical efficacy with transpedicular single vertebral osteotomy for correction treatment, and can effectively reduce perioperative complications,but the operation time and intraoperative bleeding is more.