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强直性脊柱炎后凸畸形的后路截骨矫形术及疗效分析

Clinical outcomes of surgical correction for ankylosing spondylitic kyphosis

摘要:

目的 探讨后路截骨矫形手术治疗强直性脊柱炎后凸畸形的手术方式及其疗效.方法 2003年6月至2008年6月,对21例强直性脊柱炎后凸畸形的患者行后路截骨矫形手术,其中男性17例,女性4例;年龄20~57岁,平均39.5岁.在患者术前全脊柱X线片和CT上测量躯干矢状位平衡和胸腰椎后凸角度,并在外观相上测量颌眉角.在计算机上进行模拟截骨,确定手术方式.具体手术方式有:单节段闭合截骨矫形16例;单节段前方撑开-后方闭合截骨矫形3例;胸腰段经椎弓根联合腰段Smith-Peterson截骨2例.观察患者术后矢状位失衡、颌眉角和胸腰椎后凸角度的恢复情况,并评价患者的症状恢复情况和治疗满意度.结果 手术时间平均为4.4 h,术中平均出血量为1770 ml.术前平均胸腰椎后凸角为62.1°,矢状位正失衡平均为172.9 mm,颌眉角平均为34.9°.术后平均随访28.8个月,平均胸腰椎后凸角改善率为60%;矢状位正失衡改善率为64%;颌眉角改善率为98%.随访时患者腰背痛的改善率为64%,总的治疗满意度为95%.结论 针对不同强直性脊柱炎后凸特点,在术前模拟截骨设计的基础上,采用不同的后路截骨矫形方法,可以达到较好的疗效.

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abstracts:

Objective To evaluate the clinical outcomes of posterior surgical corrective methods for ankylosing spondylitic kyphosis. Methods From June 2003 to June 2008, 21 cases of ankylosing spondylitic kyphosis received posterior surgical correction. There were 17 male and 4 female, and the average age was 39. 5 years (range, 20 to 57 years). The total spine X-ray and CT were used to evaluate sagittal balance and thoracolumbar spine kyphosis angle, and chin brow-vertical angle was obtained from clinical lateral photograph. The surgical goal was to correct sagittal imbalance and chin brow-vertical angle.The simulated osteotomy was performed in computer before surgery to determine the correction methods. The surgical methods included: 16 cases of monosegmental closing osteotomy correction, 3 cases of anterior opening-posterior closing osteotomy correction, and 2 cases of combined pedicle subtraction osteotomy in thoracolumbar spine and Smith-Peterson osteotomy in lumbar spine. All patients were followed up after surgery, and the improvement of sagittal imbalance, chin brow-vertical angle and thoracolumbar spine kyphosis angle were assessed. The symptoms relief and satisfied rate were also evaluated. Results The average operation time was 4.4hours, and the average blood loss was 1770 ml. Before surgery, the average thoracolumbar kyphosis angle was 62.1°,the average anterior shift of C7 plumb line was 172. 9 mm, and theaverage chin brow-vertical angle was 34. 9°. The average follow-up was 28. 8 months after surgery. The average correction rate of thoracolumbar kyphosis angle was 60%, the average improvement rate of anterior shift of C7 plumb line was 64%, and the average correction rate of chin brow-vertical angle was 98%. The improvement rate of back pain was 64% during follow-up. The total surgical satisfactory rate was 95%.Conclusion Based on the simulated osteotomy in computer before surgery, according to the characteristics of ankylosing spondylitic kyphosis, different posterior osteotomy and correction methods can achieve good results.

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