经椎弓根椎体间截骨联合V形截骨术矫正强直性脊柱炎合并重度胸腰椎后凸畸形

摘要

目的 评估后路联合经椎弓根椎体间截骨手术(PSO)和椎板关节突V形截骨术矫正强直性脊柱炎(AS)合并重度胸腰椎后凸畸形的临床疗效.方法 2004年8月至2007年6月,共收治AS合并重度胸腰椎后凸畸形患者8例,均为男性,年龄28～46岁,平均32岁;平均胸椎后凸角度(T1～T12)96°(80°～112°),腰椎前凸角度(L1～S1)平均10°(5°～15°),平均颏眉角47°(40°～58°),平均注视角43°(32°～50°).8例患者均在L3椎体行PSO术并在胸腰段(T12～L1,L1-2)之间进行椎板关节突V形截骨.术后综合评估影像学、临床疗效以及并发症的情况.结果 8例患者平均手术时间(298.1±20.7)min,术中失血量(1588.8±171.6)ml.8例患者均获随访,随访时间为(11.5±7.7)个月.术后平均胸椎Cobb角76.1°±9.6°,矫正20.3°±1.1°;术后平均腰椎前凸角48.4°±4.7°,矫正38.4°±4.7°.术后平均颏眉角16.5°±4.6°,注视角73.0°±5.2°.矢状面平衡矫正(12.3±1.6)cm.无血管、神经损伤、应力性骨折等重大并发症发生,术后未发生冠状面的失代偿.结论 后路联合单节段PSO联合双节段楔形截骨术矫正As合并重度后凸畸形效果安全可靠,可明显改善患者视野范围.%Objective To study retrospectively the efficacy and complications of combined pedicle subtraction osteotomy(PSO) and polysegmental closing wedge osteotomy for correction of the severe rigid thoracolumbar kyphotie deformity in ankylosing spondylitis (AS). Methods A total of 8 consecutive male patients with AS and severe thoracolumbar kyphotic deformity (mean age 32 years, range 28-46) were involved in this study from August 2004 to June 2007. The average preoperative Cobb angle of thoracic spine (T1-T12) was 96°(range, 80°-112°), the mean preoperative angle of lumbar lordosis (L1-S1) was 10°(5°-15°). The mean chin-brow angle was 47°(range, 40°-58°). The average gaze angle was 43°(range, 32°-50°). After preoperative assessment, single-level PSO was performed in L3 vertebrae and two-level polysegmental closing wedge osteotomy was performed in thoracolumbar vertebrae (T12-L1, L1-2). Radiographic and clinical results and complications were assessed. Results The surgical time was (298.1±20.7) minutes and blood loss during the procedure was (1588.8±171.6) ml. The follow-up period was (11.5±7.7) months. The postoperative angle and the amount of correction of the thoracic and lumbar spine were 76.1°±9.6°, 20.3°±1.1° and 48.4°±4.7°, 38.4~±4.7°respectively. The postoperative chin-brow and gaze angle was 16.5°±4.6° and 73.0°±5.2°, respectively. The amount of correction for sagittal balance was (12.3±1.6) cm. No nerve, vascular injury,stress fracture and coronal decompensation occurred in the patients. Conclusions Combined PSO and pelysegmental closing wedge osteotomy by posterior approach only is safe and effective for correction of the severe rigid thoracolumbar kyphotic deformity in AS. The visual field is significantly improved after surgery.