经椎弓根双椎体截骨术治疗强直性脊柱炎重度后凸畸形的临床疗效

发布时间：2018-05-07 17:14

本文选题：强直性脊柱炎 + 后凸畸形　；参考：《安徽医科大学》2015年硕士论文

【摘要】：背景经椎弓根双椎体截骨术治疗强直性脊柱炎重度后凸畸形能够很好地恢复矢状位平衡,术后效果明显,但缺乏系统的临床疗效研究。目的探讨强直性脊柱炎重度后凸畸形行经椎弓根双椎体截骨术治疗的临床疗效。方法回顾性分析自2009-1至2011-12于解放军306医院34例强直性脊柱炎重度后凸畸形患者行经椎弓根双椎体截骨术治疗的临床疗效。男22例,女12例,年龄23-62岁,平均38.3±9.6岁；病程7-30年,平均16.2±3.7年。测量所有患者的术前、术后X线片的胸椎后凸角、腰椎前凸、脊柱整体后凸角、矢状面平衡。采用B ridwell-Dewald脊柱疾患疼痛及功能评定标准进行手术前后疗效评价。结果本组所有患者均获得随访,时间12～30个月,平均20±4.6月；术中出血1800～6300ml,平均3200±147ml；手术时间280-510min,平均363±56min。身高术前为125.3±7.8cm、术后为165.4±10.3cm；颌眉角术前为92.4±8.3°、术后为13.2±11.9°；胸椎后凸角术前为72.3±14°、术后为63.4±11.5°；腰椎前凸角术前为-30±20.3°、术后为29.0±13.1°；脊柱整体后凸角术前为100.4±19.3°、术后为26.4±12.4°；C7铅垂线与骶骨后上角之间的垂直距离术前为50.3±13.4cm、术后为15.4±7.2cm。以上指标术前与术后差异有统计学意义(P-0.05)；末次随访与术后随访差异无统计学意义(P0.05).Bridwell-Dewald评分平均术前为4.0±0.4分、术后为1.6±0.2分,术前与术后评分差异有统计学意义(P0.05)。术中2例出现硬膜撕裂及脑脊液漏,术后1例出现肺部感染,术后1例出现短暂不全瘫,经治疗后均恢复良好。末次随访所有患者均无内固定断裂、脱出,均达骨性融合。结论对于AS重度后凸畸形患者,经椎弓根双椎体截骨术是一种安全、有效的术式,可以获得更大的矫正度数和满意的矢状位平衡。
[Abstract]:Background Transpedicular double vertebra osteotomy in the treatment of severe kyphosis of ankylosing spondylitis can restore sagittal balance. Objective to investigate the clinical effect of transpedicular double vertebra osteotomy for severe kyphosis of ankylosing spondylitis. Methods 34 cases of ankylosing spondylitis with severe kyphosis were retrospectively analyzed from January 2009 to December 2011 in 306 Hospital of PLA. There were 22 males and 12 females, aged 23-62 years (mean 38.3 卤9.6 years), and the course of disease ranged from 7 to 30 years (mean 16.2 卤3.7 years). Chest kyphosis, lumbar kyphosis, global kyphosis, sagittal balance were measured in all patients. Pain and function of B ridwell-Dewald spinal disease were evaluated before and after operation. Results all the patients were followed up for 12 ~ 30 months (mean 20 卤4.6 months), 1 800 卤6 300 ml (mean 3200 卤147 ml) and 280 ~ 510 min (363 卤56 min). Height was 125.3 卤7.8 cm before operation and 165.4 卤10.3 cm after surgery, 92.4 卤8.3 掳preoperatively and 13.2 卤11.9 掳postoperatively at maxillary eyebrow angle, 72.3 卤14 掳before thoracic kyphosis angle and 63.4 卤11.5 掳after operation, -30 卤20.3 掳before lumbar kyphosis angle and 29.0 卤13.1 掳after operation, 100.4 卤19.3 掳before operation and 26.4 卤12.4 掳C7 after operation with superior sacral kyphosis angle. The vertical distance between angles was 50.3 卤13.4 cm before operation and 15.4 卤7.2 cm after operation. There was no significant difference between the last follow-up and postoperative follow-up. The average score of preoperation and postoperation was 4.0 卤0.4 and 1.6 卤0.2, respectively. There was significant difference between preoperative and postoperative scores (P 0.05). Dural tear and cerebrospinal fluid leakage occurred in 2 cases, pulmonary infection in 1 case and transient incomplete paralysis in 1 case after operation. All patients recovered well after treatment. At the last follow-up, all the patients had no internal fixation fracture and extubation, all of them had bony fusion. Conclusion Transpedicular double vertebra osteotomy is a safe and effective procedure for patients with severe as kyphosis and can obtain greater correction degree and satisfactory sagittal balance.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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