外科矫形手术治疗114例强直性脊柱炎后凸畸形患者的效果分析

Effect of orthopedic surgery on treatment of 114 patients with kyphosis of ankylosing spondylitis

目的分析114例强直性脊柱炎(AS)后凸畸形患者接受不同外科矫形手术的矫正效果。方法 114例AS后凸畸形根据手术方式不同分为A组(腰椎单节段椎体截骨术,n=60)、B组(椎板"V"型截骨术,n=54)。统计2组手术效果,手术前后通过X线片测量脊柱后凸Cobb's角、站立位颌眉垂线角、矢状面失平衡距离及身高等,并评价术后脊柱疼痛及功能恢复效果。结果与A组相比,B组手术时间显著较短,术中出血量显著较少(P<0.05),且B组并发症发生率11.11%,显著低于A组的28.33%(P<0.05)。2组术后脊柱后凸Cobb's角、站立位颌眉垂线角、矢状面失平衡距离均显著减小,身高显著增高(P<0.05)。2组术后3个月脊柱疼痛及功能恢复状况比较无显著差异(P>0.05),术后6个月疼痛程度、疼痛性质、工作情况及社交情况评分均显著降低,与术后3个月相比有显著差异(P<0.05),但A、B组术后6个月脊柱疼痛及功能恢复效果无显著差异(P>0.05)。结论腰椎单节段椎体截骨术和椎板"V"型截骨术治疗AS后凸畸形均可取得较好的矫正效果,但后者手术时间短、出血量少,并发症少。

Objective To analyze the effects of different orthopedic surgeries on treatment of114 patients with kyphosis of ankylosing spondylitis（ AS）. Methods A total of 114 AS patients with kyphosis were divided into group A（ treated by lumbar single segmental vertebral osteotomy,n = 60）and group B（ treated by V-shaped laminectomy,n = 54） according to different surgical methods,and the surgical effects were evaluated. The kyphosis Cobb’s angle,standing position vertical angle of the jaw and eyebrow,sagittal equilibrium separation and height were measured through X-ray film before and after surgery. The spinal pain and functional recovery were evaluated after surgery. Results Compared with group A,the surgical time was significantly shorter and the blood loss during surgery was significantly less in group B（ P 〈 0. 05）. The incidence rate of complications in group B was11. 11%,which was significantly lower than 28. 33% in group A（ P 〈 0. 05）,but there were no significant differences between the two groups in kyphosis Cobb’s angle before surgery,standing position vertical angle of the jaw and eyebrow,sagittal equilibrium separation and height before surgery（ P 〉0. 05）. After surgery,the kyphosis Cobb’s angle before surgery,standing position vertical angle of the jaw and eyebrow,sagittal equilibrium separation decreased significantly while height increased significantly（ P 〈 0. 05）. However,the improvement of the related measurement indexes showed no significant difference between the two groups（ P 〉 0. 05）. There were no significant differences in the spinal pain and functional recovery between the two groups at 3 months after surgery（ P 〉 0. 05）. The pain degree,pain character,work condition and social status scores decreased significantly at 6 months after surgery. Compared with those at 3 months after surgery,there were significant differences（ P 〈0. 05）,but there were no significant differences between groups at 6 months after surgery（ P 〉 0. 05）.Conclusion Both lumbar single segmental vertebral osteotomy and V-shaped laminectomy are effective in the treatment of kyphosis in AS,but the surgical time of the V-shaped laminectomy is shorter,the blood loss is less,and the complications are fewer.