剪纸拼接与PS软件设计截骨矫正强直性脊柱炎后凸畸形的对比

Clinical efficacy of preoperative osteotomy designs using paper-cut technology versus photoshop software for ankylosing spondylitis with kyphosis

背景:强直性脊柱炎胸腰椎后凸畸形的术前截骨设计方法多种多样,但是均有一定误差和局限性,尚无一种便捷、精确、能被广泛接受的方法。目的:比较剪纸拼接和Photoshop(PS)软件两种术前截骨设计对强直性脊柱炎后凸畸形的矫形效果。方法:纳入2009年6月至2015年1月于延安大学附属医院脊柱外科行截骨矫形的39例强直性脊柱炎合并胸腰椎后凸畸形患者,随机分为2组,剪纸拼接组19例采用传统剪纸拼接术前截骨设计,PS组20例采用PS软件行术前截骨设计。所有病例随访12-40个月,对比两组患者术后截骨角度误差和末次随访的矫形效果。结果与结论:(1)PS组的截骨角度误差显著小于剪纸拼接组(P<0.05);(2)2组末次随访时脊柱骨盆关键矢状位参数(矢状位垂直轴、全脊柱后凸角、骨盆倾斜角)差异均有显著性意义(P<0.05),PS组显著优于剪纸拼接组;(3)PS组末次随访的Oswestry功能障碍指数和SRS-22评分显著优于剪纸拼接组,差异有显著性意义(P<0.05),但末次随访时2组目测类比评分差异无显著性意义(P>0.05);(4)综上,对比传统剪纸拼接截骨设计,PS软件截骨设计具有更小的截骨角度误差和更好的术后脊柱矢状面平衡,能够指导手术医师精准的完成截骨手术,更精确的恢复脊柱矢状面平衡以及水平视角,有效避免矫正过度或者矫正不足。

BACKGROUND： There are various kinds of design methods about preoperative osteotomy of ankylosing spondylitis with kyphosis, but each has their own errors and limitations. A convenient, precise and available method needs to be developed.OBJECTIVE： To compare the clinical efficacy of two different preoperative osteotomy designs using paper-cut and photoshop software for ankylosing spondylitis with kyphosis. METHODS： Thirty-nine patients suffering ankylosing spondylitis with kyphosis undergoing osteotomy in the Department of Spinal Surgery, Affiliated Hospital of Yan＇an University between June 2009 and January 2015 were enrolled, and randomly allotted to paper-cut （n=19） and photoshop （n=20） groups, followed by the preoperative osteotomy design, respectively. All patients were followed for 12-40 months to compare the postoperative osteotomy angle error and correction efficacy at the last follow-up between groups.RESULTS AND CONCLUSION： （1） The postoperative osteotomy angle error in the photoshop group was significantly smaller than that in the paper-cut group （P 〈 0.05）. （2） At the last follow-up, the key parameters of sagittal spine and pelvis （sagittal vertical axis, Cobb angle and pelvic tilt） showed significant differences between groups （P 〈 0.05）. （3） The Oswestry disability index and Scoliosis Research Society-22 questionnaire scores in the photoshop group were significantly superior to those in the paper-cut group at the last follow-up （P 〈 0.05）, while the visual analog scale scores did not differ significantly between groups （P 〉 0.05）. （4） To conclude, compared with the osteotomy design using traditional paper-cut splice, the photoshop software can achieve a smaller osteotomy angle error and better postoperative balance of spinal sagittal plane, thus providing precise osteotomy for surgeons to obtain proper correction.