一期后路病灶清除椎间植骨内固定治疗强直性脊柱炎Andersson病变的疗效观察

Clinical observation of one-stage posterior debridement, interbody bone graft and internal fixation for Andersson lesion in ankylosing spondylitis

目的探讨一期后路病灶清除椎间植骨内固定对强直性脊柱炎Andersson病变的治疗疗效。方法回顾性分析2008年1月至2014年7月,于我院确诊为强直性脊柱炎Andersson病变且采用一期后路病灶清除椎间植骨内固定治疗的患者9例,均为男性,年龄39~67岁,平均(52.6±7.5)岁。病变节段:T_(10~11) 1例,T_(11~12) 7例,T_(12)~L_1 1例。Frankel分级:C级6例,D级3例。评估获得随访患者的手术时间、出血量,手术前后VAS评分、Frankel评分及病变节段后凸Cobb’s角改善情况。结果所有患者均获随访,随访时间24~56个月,平均(32.8±8.75)个月,手术时间105~175 min,平均(133.9±25.3)min,失血量450~850 ml,平均(596.7±146.3)ml。术后3个月VAS评分平均为(2.80±0.43),较术前(8.53±1.11)显著降低,差异有统计学意义(P<0.05);术后24个月VAS评分平均为(1.60±0.45),较术后3个月显著降低,差异有统计学意义(P<0.05)。术后24个月Frankel评分:D级2例,E级7例。术后3个月Cobb’s角为(15.2±3.73)°,较术前(28.3±5.93)°明显改善,差异有统计学意义(P<0.05),且在术后24个月时(15.6±4.09)°矫正角度无明显丢失(P>0.05)。所有植骨均发生融合,融合时间6~13个月,平均8.6个月。结论一期后路病灶清除椎间植骨内固定可有效去除Andersson病变、恢复正常脊柱序列及显著改善患者神经功能。

Objective To investigate the clinical results of one-stage posterior debridement, interbody bone graft and internal fixation for Andersson lesion in the patients with ankylosing spondylitis （ AS ）. Methods The clinical data of 9 cases of AS complicated with Andersson lesion who underwent one-stage posterior debridement, interbody bone graft and internal fixation from January 2008 to July 2014 were retrospectively analyzed. They were all males, whose mean age was （ 52.6 ± 7.5 ） years （ range： 39 - 67 years ）. As to the lesion segment, there was 1 case of T10-11, 7 cases of T11-12 and 1 case of T12 - L1. As to the preoperative Frankel grade, there were 6 cases of Grade C and 3 cases of Grade D. The operation time, blood loss, preoperative and postoperative visual analogue scale （ VAS ） scores, Frankel grade and Cobb＇s angle improvement of the lesion segment were measured to evaluate the therapeutic effects. Results All the patients were followed up for an average period of （ 32.8 ± 8.75 ） months （ range：24 - 56 months ）. The mean operative time was （ 133.9 ± 25.3 ） min （ range： 105 - 175 min ）, and the average blood loss was （ 596.7 ± 146.3 ） ml （ range： 450 - 850 ml ）. The mean VAS score at 3 months after the operation was （ 2.80 ± 0.43 ）, which was obviously lower than （ 8.53 ± 1.11 ） before the operation, and the differences were statistically significant （ P 0.05 ）. All the cases acquired bone fusion, and the mean fusion time was 8.6 months （ range： 6 - 13 months ）. Conclusions One-stage posterior debridement, interbody bone graft and internal fixation can effectively remove the lesion, restore normal spinal alignment and significantly improve neurological functions for the AS patients complicated with Andersson lesion.