椎弓椎体楔形闭合截骨治疗强直性脊柱后凸的疗效分析

摘要

Objective To assess the effectiveness of pedicle subtraction osteotomy for correction of kyphosis caused by ankylosing spondylitis.Methods 36 consecutive patients in between May 2007 and March 2012 with kyphosis caused by ankylosing spondylitis underwent pedicle subtraction osteotomy.5 patients with preoperative existed incomplete nerve damage symptoms of lower limbs.By measuring the preoperative and postoperative imaging of the protruding after spine angle,sacral slope angle and the human body as measuring jaw angle to evaluate the efficacy of the orthopaedic eyebrow.Clinical outcome was evaluated u-sing Visual Analog Scales (VAS)score and Japanese Orthopaedic Association (JOA)score for all the pa-tients before operation and at 1 months,3 months,6 months and final follow-up.Results The operation time was between 180 and 240 min,and blood loss was between 600 and 1 000 mL (averagely 700 mL).36 patients obtained follow up with average of 25.9 months (range 10 to 36 months).Compared to pre-opera-tion,the VAS score at 1 months,3 months,6 months and the final follow-up reduced significantly (P <0.05),the JOA score at 1 months,3 months,6 months and the final follow-up increased significantly (P<0.05),convex corners of 36 patients was corrected by preoperative (78.3±23.5)°to (27.1±10.2)°.All osteotomy got solid fusion.4 patients existed temporary nerve dysfunction after postoperative,they are all recovered after 10 days.5 patients had incomplete nerve injury symptoms by preoperative,3 patients had recovered and 2 had no recovery.Conclusion The pedicle subtraction osteotomy had satisfactory effective-ness for the correction of kyphosis caused by ankylosing spondylitis,it is worthy of popularization and ap-plication of technology.%目的：探讨经椎弓椎体楔形闭合截骨治疗强直性脊柱后凸的临床疗效。方法2007年5月－2012年3月新疆医科大学第六附属医院采用经椎弓椎体楔形闭合截骨治疗强直性脊柱后凸患者36例，均为男性。5例患者术前存在下肢神经不全损伤症状，36例患者均采用经椎弓椎体楔形闭合截骨配合节段椎弓根螺钉内固定手术方式。通过测量术前、术后影像学脊柱后凸角、骶骨倾斜角和人体像测量颌眉角来评价矫形效果。观察术前与术后1、3、6个月及末次随访视觉模拟量表（visual analog scales，VAS）评分和 Oswestry 功能障碍指数（oswestry disa-bility index，ODI）的变化，衡量术后疼痛改善情况。结果手术时间3～4 h，平均3．5 h，术中出血量为600～1000 mL，平均700 mL，36例患者随访10～36个月，平均25．9个月。所有患者术后1、3、6个月及末次随访时的VAS 评分均低于术前（P ＜0．05），ODI 均低于术前（P ＜0．05），术后1、3、6个月及末次随访时的 VAS 评分和ODI 两两比较差异无统计学意义（P ＞0．05）。36例患者后凸角由术前的平均（78．3±23．5）°矫正至（27．1±10．2）°，平均矫正率为65．3％，骶骨倾斜角由术前平均（15．4±6．23）°矫正至（35．6±13．7）°，颌眉角由术前平均（37．8±12．3）°矫正至（9．2±2．5）°，差异均有统计学意义。28例患者术后随访2 a，复查 X 线及 CT 片，可见植骨已融合，矫正平均丢失率为1．9％。4例患者术后下肢出现短暂性神经功能障碍，10 d 后均完全康复，5例术前有下肢神经不全损伤症状的患者中3例有所恢复，2例无恢复。结论经椎弓椎体楔形闭合截骨对于强直性脊柱后凸的治疗效果显著，是值得推广应用的技术。