强直性脊柱炎胸腰段后凸畸形截骨术中矢状面移位的研究进展

Research progress on sagittal translation in the surgical treatment of ankylosing spondylitis

目的探讨强直性脊柱炎(AS)胸腰段后凸畸形截骨术中矢状面移位(ST)的研究进展。方法在PubMed和CNKI数据库,分别以“ankylosing spondylitis”“sagittal translation”和“强直性脊柱炎”“矢状面移位”为关键词,限定语言种类为English和中文,检索1970年1月—2021年7月发表的有关AS胸腰段后凸畸形截骨术ST的文献共109篇,剔除内容不符、无法获取全文、重复性研究的文献,最终纳入36篇进行分析。结果ST发生率为1.6%~27%,头端移位更多见,产生的原因主要包括截骨水平头侧及尾侧椎体置钉深度不一致、矫形棒铰链点与截骨平面不在同一水平、截骨时上下截骨面矢状径不等、后凸矫正过大、改良Stoke强直性脊柱炎脊柱评分较高。预防措施主要包括术中使用临时固定棒和cage、复位导向器、可调式手术体位架。一旦出现ST,需尽快行硬膜和神经根减压,具体措施包括椎板和/或椎弓根切除减压、ST的复位。部分ST会出现神经症状,其术后神经功能的恢复情况存在着较大差异,不同文献中对ST的判定标准不同可能是出现差异的重要原因。结论AS截骨矫形术中ST的发生与置钉深度、矫形棒曲度、截骨面对称度密切相关,尽快行硬膜和神经根减压以及ST复位是避免神经功能损伤进一步恶化的有效措施。ST的椎管自发性重塑形的发生机制目前尚不得而知,有待于今后继续研究。

Objective This study aimed to explore the research progress on sagittal translation(ST)in the surgical treatment of ankylosing spondylitis(AS)with thoracolumbar kyphosis.Methods A computer-based online search in PubMed and CNKI databases was performed to identify articles about"sagittal translation"and"ankylosing spondylitis"published in English from January 1970 to July 2021 and articles about"强直性脊柱炎"and"矢状面移位"published in Chinese from January 1970 to July 2021.A total of 109 pieces of literature were searched,and 36 pieces of literature were included after excluding those with inconsistent content,inaccessible full text,and repetitive research.Results The incidence of ST was 1.6%-27%,and cephalad displacement was commonly observed.The main reasons of ST included the inconsistency of the depth of pedicle screw insertion between the cephalad and caudal vertebral body,inconsistency of the hinge point of the rod and osteotomy space,inconsistency of the osteotomy space between the cephalad and caudal vertebral body,large correction of kyphosis,high modified Stoke ankylosing spondylitis spine score.Preventive measures included the use of temporary fixation rods and cages,reduction guides,and adjustable surgical postures during operation.Once ST occurred,dural and nerve root decompression should be performed immediately.Surgical intervention included laminectomy and/or pedicle resection,decompression,and ST reduction.Not all ST presented neurological symptoms,and differences in the recovery of neurological function were observed after surgery.The difference in ST criteria among the included literature may be of importance.Conclusion ST in AS osteotomy is closely related to the depth of pedicle screw insertion,the curvature of the rod,and the symmetry of the osteotomy surface.Immediate dural and nerve root decompression and ST reduction are considered as effective measures to prevent further deterioration of nerve function.The mechanism of spontaneous remodeling of the spinal canal following ST is currently unknown.Thus,it needs to be further studied in the future.