强直性脊柱炎胸腰椎后凸畸形两种截骨矫形术式的疗效比较

Clinical comparison of two different osteotomy correction techniques for kyphosis deformity of ankylosing spondylitis

目的探讨治疗强直性脊柱炎胸腰椎后凸畸形的两种截骨矫形术式、截骨范围及内固定范围的选择。方法共54例,男49例,女5例;年龄25～56岁,平均36岁。其中多节段经关节突“V”形截骨23例(A组),单节段经椎弓根椎体截骨31例(B组)。结果术后无感染、死亡发生;术中硬脊膜破裂2例(A组和B组各1例),椎弓根骨折1例(A组);术后下肢短暂性麻木2例(B组),肠系膜上动脉综合征1例(A组)。术后平均矫正度:行多节段经关节突“V”形截骨者为44°,单节段经椎弓根椎体截骨者为36°。随访11～45个月,平均20个月,A组矫正度丢失平均为6°,B组为3°,但均达骨性融合。A组有1例发生椎弓根螺钉早期松动。A、B两组患者主观满意率分别为95.7%和93.5%。结论以上两种截骨方式治疗强直性脊柱炎胸腰椎后凸畸形的临床效果相似,可根据脊柱前柱是否完全骨化来选择术式。偏心椎板钩的使用是解决术中内固定困难的有效方法。

Objective To investigate the indications of two different osteotomy techniques for the correction of kyphosis secondary to ankylosing spondylitis and evaluate the selection of osteotomy level, instrumentation area and their clinical outcomes. Methods Fifty four patients (male 49, female 5) were converged in this study with mean age 36 years(ranging from 25 to 56 years). These patients were divided into two groups according to the different osteotomy techniques. Group A: 23 cases were operated on with multi-segmental vertebral body 'V' shaped osteotomy; Group B: 31 cases were operated on with single-level transpedicular wedge osteotomy. These two different osteotomy techniques were selected depending on the ossification of the discs. After correction of kyphosis deformity all cases underwent transpedicular screw instrumentation and autogenous bone grafting. Results No death or infection occured. Two cases of dural tear (one for each group) and 1 case of pedicle fracture occured during operation in group A, transient lower extremity numbness were seen in 2 patients in group B, superior mesenteric artery syndrome (SMAS) was found in 1 case in group A. The mean correction in Cobbs angle for multi-segmental 'V' shaped osteotomy group was 44°, whereas for single-level transpedicular wedge osteotomy group it was 36°. After a mean follow-up of 20 months ranging from 11 to 45 months, the average correction loss of 6° was seen in group A, 3° correction loss in group B. The patient satisfactory rate was 95.7% and 93.5% in group A and group B respectively. Conclusion Similar clinical outcomes were seen in two groups with different osteotomy techniques in terms of correction rate, complication and patients satisfactory rate. The main decisive factor to select the osteotomy techniques is the extent of anterior vertebral column ossification. Offset laminar hook is a good resolution for enforcing internal fixation in case of osteoporosis.