单纯后柱缩短截骨矫形治疗强直性脊柱炎后凸畸形合并病理性骨折

Single posterior column shortening osteotomy for treatment of kyphosis in ankylosing spondylitis patients with pathological fracture

[目的]评价通过经骨折线单纯后柱缩短截骨矫形治疗强直性脊柱炎后凸畸形合并病理性骨折的疗效。[方法]收集本中心强直性脊柱炎后凸畸形合并病理性骨折行经骨折线单纯后柱缩短截骨矫形的手术患者13例;年龄2252岁,平均36.8岁。通过术前术后VAS评分,术前、术后及随访时矢状面X线片,测量全脊柱后凸角、胸腰段后凸角、腰椎前凸角、C7铅垂线和S1后上角的距离,评价症状改善及矫形效果。[结果]13例患者平均随访2.1年,其中2例未满1年（1例6个月,1例3个月）,1例患者术后出现手术切口感染,经更换抗生素后治愈。所有患者脊柱后凸角（GK）从术前平均（55.8±11.0）°下降到术后平均（23.2±6.7）°,P<0.001;C7铅垂线至骶骨后上角的距离（C7S1）从术前的平均（166±37）mm下降到术后的平均（111±20）mm,P<0.001;胸腰段后凸角（TLK）从术前的平均（51.0±9.9）°下降到术后平均（21.6±11.0）°;P<0.001;患者疼痛视觉模拟评分（VAS评分）从术前平均（7.2±1.2）分下降到术后平均（2.1±1.1）分,P<0.001;腰椎前凸角（LL）从术前平均（5.7±23.2）°增加到术后平均（10.5±29.0）°,P=0.001。[结论]经病理性骨折线单纯后柱缩短截骨矫形是治疗强直性脊柱炎后凸畸形合并病理性骨折的有效方法,可在显著改善患者腰背部疼痛症状的同时取得良好的矫形效果。

[Objective] To evaluate the clinical outcomes of single posterior column shortening osteotomy for the treatment of kyphasis in ankylosing spondylitis patients with pathological fracture. [Methods] A total of 13 patients who were diagnosed with ankylosing spondylitis kyphosis with pathological fracture and underwent single posterior column shortening via corrective osteotomy in Xiangya Hospital of Central South University were enrolled,with an age of 22 ~ 52 years( mean 36. 8 years). The Visual Analogue Scale( VAS) scores before and after treatment,the sagittal X- ray films before and after treatment and during follow- up,kyphotic angle,and the distance between C_7 plumb line and posterosuperior corner of the sacrum S_1 were measured to evaluate the improvement in symptoms and the correction result. [Results] The mean follow- up time was 2. 1 years,and among these patients,2 were followed up for less than 1 year( 1 for 6 months and 1 for 3 months). One patient experienced infection of the surgical incision after surgery and recovered after the replacement of antibiotics. The mean kyphosis angle( 55. 8° ±11. 0° vs 23. 2° ± 6. 7°,P < 0. 001),the mean distance between C_7 plumb line and posterosuperior corner of the sacrum( C_7~S_1)( 166 ± 37 mm vs 111 ± 20 mm,P < 0. 001),the mean thoracolumbar kyphosis( 51. 0° ± 9. 9° vs 21. 6° ± 11. 0°,P <0. 001),and the mean pain score( VAS score)( 7. 2 ± 1. 2 vs 2. 1 ± 1. 1,P < 0. 001) reduced significantly after surgery,and the mean lumbar lordosis increased significantly after surgery( 5. 7° ± 23. 2° vs 10. 5° ± 29. 0°,P = 0. 001). [Conclusion]Single posterior column shortening osteotomy through a pathological fracture gap is an effective method for kyphosis eorrection in ankylosing spondylitis with pathological fracture and can significantly reduce lower back pain.