摘要
目的探讨后路截骨治疗强直性脊柱炎(AS)患者后凸畸形的效果。方法选择60例AS并后凸的患者,男35例,女25例;年龄25～54岁,平均33岁;身高148～172 cm,平均身高162.3 cm。矢状面不同的Cobb's角:T_5～T_(12)70°～120°,平均83°;T_(11)～L_2 5°～51°,平均37°;胸腰段后凸Cobb's角(多集中在T_(10)～L_2)35°～97°,平均48.6°;L_1～L_5 32°～-8°,平均4°。颌眉垂线角41°～84°,平均53.3°。均无明显神经症状。分别采用顶椎区Smith-Petersen脊柱截骨、改良式多个节段Smith-Petersen脊柱截骨、"三明治"式截骨、Thomasen经椎弓根截骨、椎体切除5种不同的截骨方法来矫正后凸畸形。内固定全部选用椎弓根螺钉技术。其中,顶椎区Smith-Petersen脊柱截骨12例;改良式多个节段Smith-Petersen脊柱截骨28例;"三明治"式截骨5例;Thomasen经椎弓根截骨10例;椎体切除5例。结果术后患者平均身高增长8.7 cm,矢状面不同的Cobb's角:T_5～T_(12)30°～60°,平均43.2°; T_(11)～L_2-2°～11.3°,平均3.8°;胸腰段后凸畸形Cobb's角(多集中在T_(10)～L_2):-2°～12.7°,平均5.6°;L_1～L_5 21°～-38°,平均32.8°.颌眉垂线角-8°～15.8°,平均8.3°,均无明显神经症状。随访2～10年,截骨部位均在6～12个月时,出现椎体间和椎板的骨性融合。术后外形明显改善,心肺功能好转。结论治疗强直性脊柱后凸,对于不同程度的后凸应当采用不同的截骨方式。椎板截骨多适用于后凸较轻、椎体前缘无明显骨性融合的患者,对于骨质疏松明显、椎体前方骨桥明显的患者应当选择三柱截骨,对于后凸角度较大,顶椎有楔形变的严重AS患者应当采用顶椎区一个或多个椎体切除。
Objectives To explore the effectivenss of corrective posterior osteotomy and selective internal fixation in treating of ankylosing spondylitis kyphosis.Methods Sixty patients(35 men and 25 women) were enrolled in this study with a mean age of 33 years(ranging from 25 to 54 years).Body height ranged 148～172cm(mean 162.3 cm).Preoperative sagittal kyphosis Cobb's angle;T_5～T_(12) 70°～120°,mean83°;T_(11)～L_2 5°～51°,mean 37°;thoracolumbar kyphosis Cobb's angle:(mainly focused on the level T_(10)～L_2):35°～97°,mean 48.6°;and L_1～L_5 32°～-8°,mean 4°.The angle between the line drawn from the eyebrow to jaw line and vertical;41°～84°,mean 53.3°.All patients were divided into 5 groups according to different osteotmy techniques used:single-segmental Smith-Petersen osteotmy of the apex vertebrae(12 cases),multi-segmental Smith-Petersen osteotmy(28 cases),'hamburger'osteotmy(5 cases), Thomasen osteotmy(10 cases),and vertebrae resection(5 cases).All patients underwent internal fixation with pedicle screw instrumentation.Results The body height increased by an average of 8.7cm.The postoperative sagittal kyphosis Cobb's angle;T_5～T_(12) 30°～60°,mean 43.2°;T_(11)～L_2 -2°～11.3°,mean 3.8°;the thoracolumbar kyphosis Cobb's angle:(mainly focusing on T_(10)～L_2 level):-2°～12.7°,mean 5.6°;L_1～L_5 21°～-38°,mean 32.8°.The angle between the line drawn from eyebrow to jaw and vertical;-8°～15.8°,mean 8.3°.All cases were followed up for 2 to 10 years.Osteotomy site later indicated synostoses occurrence of intervertebral and posterior lamina within 6 to 12 months after operation.The physical appearance of all patients were obviously corrected and improved,and their cardiopulmonary function greatly improved.Conclusions Modified osteotomy should be customized in treatment of ankylosing spondylitis kyphosis. Lamina osteotomy is suitable for patients with slight kyphosis and without obvious synostoses.For patients with severe kyphosis and osteoporosis,three-column osteotomy is preferred.Vertebreae resection should be chosen for patients with sharp and severe kyphosis,which requires the resection of the apex and nearby vertebrae.
出处
《中国骨与关节外科》
2008年第2期108-113,共6页
Chinese Journal of Bone and Joint Surgery
