强直性脊柱炎重度胸腰段后凸畸形患者的双节段截骨设计

Design of two-level osteotomy for ankylosing spondylitis patients with severe thoracolumbar kyphosis

目的设计强直性脊柱炎(AS)重度胸腰段后凸畸形患者的双节段截骨方法,并进行评估。方法回顾性分析2011年1月—2012年12月于本院接受双节段截骨设计及手术矫形的10例AS重度胸腰段后凸畸形合并腰椎前凸角度减小患者临床资料,包括手术前后包含骨盆的自然站立位脊柱全长X线片,手术前后及末次随访时的T_5~S_1 Cobb角、胸腰段后凸角(TLK)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)及矢状面偏移(SVA)等相关影像学参数,以及术前及术后1年随访时患者生活质量,使用健康相关生活质量(HRQoL)量表评估,通过对比评价双节段截骨手术矫形效果。结果与术前相比,术后T_5~S_1 Cobb角、PT、TLK及SVA均减小,差异有统计学意义(P<0.05);LL及SS增大,差异有统计学意义(P<0.05);PI无明显改变。术后1年随访时HRQoL得分较术前明显改善,差异有统计学意义(P<0.05)。结论双节段截骨设计为AS胸腰段后凸畸形合并腰椎前凸角度减小患者的矫形提供了精确且可重复的方法,可使患者获得满意的矫形效果及生活质量。

Objective To design and assess a two-level osteotomy for severe thoracolumbar kyphosis in patients with ankylosing spondylitis(AS). Methods From January 2011 to December 2012,10 consecutive severe thoracolumbar kyphosis patients caused by AS who underwent two-level spinal osteotomy were studied. Pre-and postoperative full-length free-standing radiographs,including the whole spine and pelvis,were available for all the patients. Pre-and postoperative radiological parameters,including T_5-S_1 Cobb's angles,thoracolumbar kyphosis(TLK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),and sagittal vertical axis(SVA) were measured and compared. Health related quality of life(HRQo L) was administered prior to surgery and during 1-year follow-up. Results Compared with preoperative,T_5-S_1 Cobb's angle,PT,TLK and SVA were decreased,and the difference was statistically significant(P < 0.05). Compared with preoperative,LL and SS were increased,and the difference was statistically significant(P < 0.05). Compared with preoperative,there was no obvious change in PI. HRQo L scores at 1-year follow-up were significantly improved compared to those at pre-operation,and the difference was statistically significant(P < 0.05). Conclusion This calculation of two-level osteotomy provides an accurate and reproducible method for correction of AS. By which,we can obtain satisfactory radiological parameters and clinical outcomes.