经椎弓根双椎体截骨术治疗重度强直性脊柱炎后凸畸形的疗效观察(1)
摘 要 目的：觀察重度强制性脊柱炎后凸畸形应用经椎弓根双椎体截骨术治疗的效果。方法：以76例重度强直性脊柱炎后凸畸形患者为研究对象，随机分成观察组和对照组各38例，分别采用经椎弓根双椎体截骨术、经椎弓根单椎体截骨术治疗，观察治疗效果。结果：术前、术后1、6个月，两组脊柱后凸Cobb’s角、站立位颌眉垂线角、SVA无显著差异(P>0.05)；但两组术后1、6个月测量结果均显著低于术前(P<0.05)；观察组并发症发生率显著低于对照组(P<0.05)。结论：重度强直性脊柱炎后凸畸形应用经椎弓根双椎体截骨术治疗时，可获得相当于以往截骨矫正术的治疗效果，且可减少术后并发症，安全有效。
关键词 经椎弓根双椎体截骨术 强直性脊柱炎 后凸畸形
中图分类号：R681.51 文献标志码：B 文章编号：1006-1533(2018)21-0044-03
Effect of transpedicular double vertebral osteotomy on severe ankylosing spondylitis kyphosis
BAI Chaojie*
(the Central Hospital of Yongcheng City， He’nan Yongcheng 476600， China)
ABSTRACT Objective： To observe the effect of vertebral pedicle double pyramidal osteotomy in the treatment of severe and coercive spondylitis. Methods： Seventy-six patients with severe ankylosing spondylitis and kyphosis were randomly divided into an observation group and a control group with 38 cases each. The observation group were treated by transpedicular double vertebral osteotomy while the control group by transpedicular single vertebral osteotomy and their effects were compared. Results： There were no significant differences in Cobb’s angle， standing mandibular eyebrow vertical line angle and SVA between the two groups before and after operation (P>0.05). However the measurement results at 1 and 6 months after surgery in both groups were significantly lower than that before surgery (P<0.05) and the incidence of complications was also significantly lower in the observation group than the control group (P<0.05). Conclusion： The efficacy of the pedicle bipyramidal osteotomy in the treatment of severe ankylosing spondylitis protrusion deformity is comparable to previous osteotomy， it can reduce the postoperative complications with good safety and effectiveness.
KEy WORDS vertebral pedicle double pyramidal osteotomy； ankylosing spondylitis； kyphosis
强直性脊柱炎属于慢性自身免疫性疾病，中轴骨及外周大关节为主要累及部位，病情逐步进展后，脊柱后凸畸形会出现，腰背部疼痛，难以站立、行走等为临床表现，甚至会对呼吸、消化及神经系统功能产生影响。临床治疗重度强直性脊柱炎后凸畸形患者时，手术矫正为主要方法，常用术式为截骨矫形术，可恢复脊柱矢状面平衡，治疗效果良好，但患者后凸70°以上时，利用多节段经关节突“V”形截骨术等传统截骨矫形术治疗后，并不能获得理想的矫正效果，也容易发生螺钉松动、截骨断端移位等并发症，严重影响患者脊柱功能，降低患者日常生活自理能力，预后较差[1]。研究指出，重度强直性脊柱炎后凸畸形应用经椎弓根双椎体截骨术治疗后，可获得较为理想的矫正效果[2]。因此，本院尝试应用经椎弓根双椎体截骨术治疗重度强直性脊柱炎后凸畸形患者，效果如下。
1 资料与方法
1.1 一般资料
选择本院2016年4月—2017年8月接收的重度强直性脊柱炎后凸畸形患者76例，男42例，女34例；年龄32～77岁，平均(43.8±5.7)岁；病程3～17年，平均(12.7±2.6)年；脊柱后凸Cobb’s角73°～109°，平均(82.7±13.0)°；矢状面轴向距离(SVA)12～35 cm，平均(19.3±4.7)cm；站立位颌眉垂线角46°～140°，平均(68.3±19.6)°。纳入标准：①符合强直性脊柱炎诊断标准；②脊柱后凸Cobb’s角70°以上；③脊柱前柱完全骨化或腹主动脉钙化；④胸腰段或腰椎为后凸顶椎位置；⑤经医院伦理委员会批准；⑥知情同意。排除标准：①合并颈胸段后凸畸形；②存在明显手术禁忌证。随机分为观察组和对照组各38例，两组一般资料无显著差异(P>0.05)。, 百拇医药(白超杰)
关键词 经椎弓根双椎体截骨术 强直性脊柱炎 后凸畸形
中图分类号：R681.51 文献标志码：B 文章编号：1006-1533(2018)21-0044-03
Effect of transpedicular double vertebral osteotomy on severe ankylosing spondylitis kyphosis
BAI Chaojie*
(the Central Hospital of Yongcheng City， He’nan Yongcheng 476600， China)
ABSTRACT Objective： To observe the effect of vertebral pedicle double pyramidal osteotomy in the treatment of severe and coercive spondylitis. Methods： Seventy-six patients with severe ankylosing spondylitis and kyphosis were randomly divided into an observation group and a control group with 38 cases each. The observation group were treated by transpedicular double vertebral osteotomy while the control group by transpedicular single vertebral osteotomy and their effects were compared. Results： There were no significant differences in Cobb’s angle， standing mandibular eyebrow vertical line angle and SVA between the two groups before and after operation (P>0.05). However the measurement results at 1 and 6 months after surgery in both groups were significantly lower than that before surgery (P<0.05) and the incidence of complications was also significantly lower in the observation group than the control group (P<0.05). Conclusion： The efficacy of the pedicle bipyramidal osteotomy in the treatment of severe ankylosing spondylitis protrusion deformity is comparable to previous osteotomy， it can reduce the postoperative complications with good safety and effectiveness.
KEy WORDS vertebral pedicle double pyramidal osteotomy； ankylosing spondylitis； kyphosis
强直性脊柱炎属于慢性自身免疫性疾病，中轴骨及外周大关节为主要累及部位，病情逐步进展后，脊柱后凸畸形会出现，腰背部疼痛，难以站立、行走等为临床表现，甚至会对呼吸、消化及神经系统功能产生影响。临床治疗重度强直性脊柱炎后凸畸形患者时，手术矫正为主要方法，常用术式为截骨矫形术，可恢复脊柱矢状面平衡，治疗效果良好，但患者后凸70°以上时，利用多节段经关节突“V”形截骨术等传统截骨矫形术治疗后，并不能获得理想的矫正效果，也容易发生螺钉松动、截骨断端移位等并发症，严重影响患者脊柱功能，降低患者日常生活自理能力，预后较差[1]。研究指出，重度强直性脊柱炎后凸畸形应用经椎弓根双椎体截骨术治疗后，可获得较为理想的矫正效果[2]。因此，本院尝试应用经椎弓根双椎体截骨术治疗重度强直性脊柱炎后凸畸形患者，效果如下。
1 资料与方法
1.1 一般资料
选择本院2016年4月—2017年8月接收的重度强直性脊柱炎后凸畸形患者76例，男42例，女34例；年龄32～77岁，平均(43.8±5.7)岁；病程3～17年，平均(12.7±2.6)年；脊柱后凸Cobb’s角73°～109°，平均(82.7±13.0)°；矢状面轴向距离(SVA)12～35 cm，平均(19.3±4.7)cm；站立位颌眉垂线角46°～140°，平均(68.3±19.6)°。纳入标准：①符合强直性脊柱炎诊断标准；②脊柱后凸Cobb’s角70°以上；③脊柱前柱完全骨化或腹主动脉钙化；④胸腰段或腰椎为后凸顶椎位置；⑤经医院伦理委员会批准；⑥知情同意。排除标准：①合并颈胸段后凸畸形；②存在明显手术禁忌证。随机分为观察组和对照组各38例，两组一般资料无显著差异(P>0.05)。, 百拇医药(白超杰)