腰段单节段去松质骨化截骨治疗强直性脊柱炎后凸畸形的疗效分析

Therapeutic Effect of Single Segmental Lumbar Vertebral Column Decancellation for the Treatment of Kyphosis in Ankylosing Spondylitis

目的:综合评价后路腰段单节段去松质骨化截骨(VCD)治疗强直性脊柱炎胸腰椎后凸畸形的临床疗效。方法:回顾性分析2008年5月—2017年6月收治的42例强直性脊柱炎脊柱后凸畸形患者的临床资料,均接受L2单节段VCD截骨矫形手术。所有患者手术前后均摄站立位、全脊柱正侧位X线片测量胸椎后凸(TK)、腰椎前凸(LL)及矢状面平衡(SVA),进行统计;记录矫形前后ODI评分、BASFI评分和BASDAI评分(术后> 2年);分析总结患者影像学指标、临床症状两者之间的关系。结果:平均手术时间为(156±34) min,术中出血量平均为(1 450±150) ml。平均TK角度由(49. 6±11. 7)°矫正为(37. 3±9. 2)°,平均LL角度由(-1. 8±8. 9)°矫正为(-36. 9±8. 5)°,平均SVA由(110. 8±30. 7) mm矫正为(39. 7±34. 3) mm。所有患者的ODI、BASFI、BASDAI较术前均有不同程度的改善;各影像学指标的改善与不同的临床症状间存在直线相关关系。结论:后路腰段单节段VCD截骨矫形可矫正TK角度,明显改善患者的外观、生活质量及功能评分。

Objective:The aim of this study was to evaluate clinical results after single segmental lumbar vertebral column decancellation surgical correction for the treatment of kyphosis in ankylosing spondylitis.Methods:42 ankylosing spondylitis(AS)patients with thoracolumbar kyphosis underwent spinal osteotomy from May 2008 to June 2017 in our hospital,were retrospectively reviewed.A series of spinopelvic parameters including thoracic kyphosis(TK),lumbar lordosis(LL)and sagittal vertical axis(SVA)measured on preoperative and postoperative free-standing radiographs were obtained and analyzed by regional curves.As well,clinical assessments were performed with Oswestry disabiuty index(ODI)and the Bath Ankylosing Spondylitis Activity and Function Index(BASDAI and BASFI)so as to seek correlations between radiological parameters and symptoms.Each of the above measurements was recorded before and 1 year after the surgery.The changes derived from each measurement before and after the surgery were evaluated.We also analyze the correlations between the radiological and clinical results.Results:Mean operative time was(156±34)min and intraoperative blood loss was(1 450+150)ml.Mean thoracic kyphosis changed from(49.6±11.7)°to(37.3±9.2)°.Mean lumbar lordosis was corrected from(-1.8±8.9)°to(-36.9±8.5)°,and the SVA was improved from(110.8±30.7)mm to(39.7±34.3)mm.There was significant improvement in the ODI,BASDAI,BASFI.Conclusion:The results of this study show that posterior VCD can correct TK which is important in improving the patient's appearance,quality of life and functional score.