O型臂导航系统辅助截骨矫形内固定治疗强直性脊柱炎胸腰椎后凸畸形

O-arm navigation assisted osteotomy and instrumentation in the treatment of thoracolumbar kyphosis in ankylosing spondylitis

目的探讨O型臂导航系统辅助截骨矫形内固定治疗强直性脊柱炎(AS)胸腰椎后凸畸形的可行性和临床效果。方法分析2018年5月至2022年5月河南省人民医院手术治疗的23例AS胸腰椎后凸畸形患者的临床资料,其中男21例,女2例,平均年龄(36.09±9.54)岁。手术采用O型臂导航系统辅助置钉、导航术中规划截骨及导航可视化超声骨刀截骨技术进行脊柱截骨矫形内固定术。记录手术时间、术中出血量、术中及术后出现的并发症。测量术前、术后2周及末次随访时脊柱整体后凸角(GK)、胸椎后凸角(TK)、腰椎前凸角(LL)、矢状面平衡距离(SVA)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS);采用SF-36量表评估术前和末次随访时患者的生活质量。术前、术后与末次随访的资料采用配对t检验。结果所有患者均顺利完成手术,平均手术时间为(324.35±55.91)min、出血量为(1315.00±373.14)ml,无1例发生置钉相关并发症,术后2例出现短暂性下肢神经根性症状。术前GK为(61.60±13.84)°,术后为(31.35±7.96)°(t=16.635,P<0.01);术前TK为(48.08±10.17)°,术后为(44.73±11.18)°(t=4.974,P<0.01);术前LL为(-0.78±15.73)°,术后为(36.91±9.19)°(t=-10.231,P<0.01);术前SVA为(143.13±32.63)cm,术后为(47.30±23.67)cm(t=16.293,P<0.01);术前PT为(39.13±7.30)°,术后为(22.01±5.95)°(t=6.619,P<0.01);术前SS为(14.75±8.51)°,术后为(31.75±8.89)°(t=-6.686,P<0.01)。末次随访时GK[(31.35±7.96)°、TK[(44.73±11.18)°、LL[(36.91±9.19)°、SVA[(47.30±23.67)cm、PT[(22.01±5.95)°、SS[(31.75±8.89)°]与术后2周比较,差异均有无统计学意义(t=-1.974、-1.624、1.825、-1.702、-0.124、-0.125,P>0.05)。末次随访时患者躯体疼痛、一般健康状况、活力、社会功能、情感职能较术前均得到明显改善(59.13±8.81比45.43±10.75,t=-1.338,P<0.01;73.75±9.21比54.96±11.10,t=-11.915,P<0.01;49.57±11.41比44.17±12.47,t=-2.531,P<0.05;66.34±11.24比61.43±10.43,t=-2.361,P<0.05;65.65±10.17比56.43±11.14,t=-10.342,P<0.01)。结论O型臂导航系统辅助截骨矫形治疗AS胸腰椎后凸畸形的临床效果满意,置钉和截骨均具有良好的精准性与安全性。

Objective:To evaluate the feasibility and clinical effectiveness of osteotomy and instrumentation with O-arm navigation system in the treatment of thoracolumbar kyphosis in ankylosing spondylitis(AS).Methods:From May 2018 to May 2022,the data of 23 AS patients with thoracolumbar kyphosis was retrospectively analyzed in Henan Provincial People’s Hospital.There were 21 males and 2 females,with the average age of 36.09±9.54 years.All the patients underwent spinal deformity correction surgery under the O-arm guidance system.The operation time,blood loss and complications were recorded.The average global kyphosis(GK),thoracic kyphosis(TK),lumbar lordosis(LL),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS)were measured before operation,2 weeks after operation,and at the last follow-up.SF-36 questionnaire was used to evaluate the life quality.Paired t-test was used for preoperative,postoperative,and final follow-up data.Results:Kyphosis deformity correction surgery was successfully performed using O-arm navigation system in all the patients.The average operative time was(324.35±55.91)min,and the average blood loss was(1315.00±373.14)ml,No one occurred screw placement relevant complication,Except for two transient radiculopathies of lower extremity,no other neurological deficit was observed.The GK was corrected from(61.60±13.84)°,before operation to(31.35±7.96)°(t=16.635,P<0.01)after operation,TK was from(48.08±10.17)°to(44.73±11.18)°(t=4.974,P<0.01),LL from(-0.78±15.73)°to(36.91±9.19)°(t=-10.231,P<0.01),SVA from(143.13±32.63)cm to(47.30±23.67)cm(t=16.293,P<0.01),PT from(39.13±7.30)°to(22.01±5.95)°(t=6.619,P<0.01)and SS was from(14.75±8.51)°to(31.75±8.89)°(t=-6.686,P<0.01).There were no significantly different between the parameters of GK[(31.35±7.96)°],TK[(44.73±11.18)°],LL[(36.91±9.19)°],SVA[(47.30±23.67)cm],PT[(22.01±5.95)°],SS[(31.75±8.89)°]at 2 weeks after operation and those at the last follow-up(t=-1.974,-1.624,1.825,-1.702,-0.124,-0.125,P>0.05).At the last follow-up,the patient’s physical pain,general health status,vitality,social function,and emotional function showed significant improvement(59.13±8.81 vs.45.43±10.75),t=-1.338,P<0.01;73.75±9.21 vs.54.96±11.10,t=-11.915,P<0.01;49.57±11.41 vs.44.17±12.47,t=-2.531,P<0.05;66.34±11.24 vs.61.43±10.43,t=-2.361,P<0.05;65.65±10.17 vs.56.43±11.14,t=-10.342,P<0.01).Conclusion:O-arm navigation assisted osteotomy and instrumentation is an effective method in the treatment of thoracolumbar kyphosis in AS,and increased the accuracy and safety in screw placement and osteotomy.