摘要
目的通过对78例强直性脊柱炎（AS）胸腰椎后凸畸形自然史的分析，探讨手术矫形时机选择。方法本组78例，男性69例，女性9例，年龄22～56岁，平均38岁。后凸畸形Cobb角40°～87°，平均61°。多节段V形截骨术28例、经椎弓根椎体截骨术50例。根据病史回顾和后凸畸形的病程，本组患者后凸畸形的进展可分为4个阶段：腰痛期、后凸畸形缓慢性进展期、加速进展期及稳定期。结果腰痛期1～10年，平均5年，缓慢进展性后凸畸形期1～8年，平均3年，后凸畸形加速进展期1～5年，平均3年，稳定期1～8年，平均4年。随访4～60个月，平均49个月。术后矫正度（40±11）°，末次随访时平均丢失5°。74例（95％）优良，4例（5％）为好，无疗效为一般或差的病例。结论As胸腰椎后凸畸形截骨矫形的手术时机除了正确掌握适应证外，还必须满足下列条件：腰痛停止6个月以上（腰椎力学性疼痛除外）；血沉连续2次正常；C反应蛋白阴性。
Objective The purpose of this study is to explore the time of osteotomy for thoracolumabar or lumbar kyphosis secondary to ankylosing spondylitis （AS） by analyzing the natural history of 78 AS patients. Methods Seventy-eight patients including 69 male and 9 female were involved into this study. The mean age at the time of surgery was 38 years （range： 22-56 years）. The average preoperative deformity was 61° （range： 40° to 87°）. Twenty-eight patients underwent ＂V-shape＂ osteotomy, and 50 patients underwent transpedicular ostentomy.Kyphosis progression of these 78 patients was classified into four stages （lumbar pain stage, slowly progressive kyphosis stage, accelerated progressive kyphosis stage, stablized kyphosis stage） based on disease course and retrospectively history reviewing. Results The average duration of lumbar pain stage was 5 years （range： 1 to 10 year）, the average duration of slowly progressive kyphosis stage, accelerated progressive kypho- sis stage and stabhzed kyphosis stage was 3 years （range： 1 to 8 year）, 4 years （range： 2 to 10 year）, and 4 years （range： 1 to 8 year） respectively. Patients were followed up for a period of 4-60 months （mean 49 months）. The total postoperative correction was （40±11）° the average loss of correction was 5° at the final fol- low-up. Excellent results were obtained in 74 patients （95%）, and good results were obtained in 4 patients （5%）, there were no fair or poor results. Conclusion Besides the appropriate indications, other criteria such as lumbar pain stops for more than 6 months （except mechanical lumbar pain）, normal blood sedimentation rate for two times, negative C reactive protein, must be considered when choosing the right time of osteotomy for thoracolumabar or lumbar kyphosis secondary to ankylosing spendylitis.
出处
《中华风湿病学杂志》
CAS
CSCD
2007年第2期101-104,共4页
Chinese Journal of Rheumatology
