强直性脊柱炎胸腰段脊柱后凸截骨术矢状面移位患者椎管自发重塑形现象

发布时间：2018-06-07 00:20

本文选题：强直性脊柱炎 + 经椎弓根截骨术　；参考：《中国脊柱脊髓杂志》2017年02期

【摘要】：目的:观察强直性脊柱炎(ankylosing spondylitis,AS)脊柱后凸畸形截骨术发生矢状面移位(sagittal translation,ST)患者椎管形态的变化以及椎管自发重塑形现象。方法:回顾性分析2011年1月~2014年12月于我院行经椎弓根截骨术发生ST的16例AS胸腰段脊柱后凸畸形患者,男14例,女2例,年龄28~55岁(38.6±8.4岁)。均于手术前后及末次随访时拍摄自然站立位全脊柱正侧位X线片以及ST节段三维CT扫描,分别测量全脊柱后凸角(GK)、胸腰段后凸角(TLK)、腰前凸角(LL)、矢状面偏移(SVA)以及ST的大小,观察术后及末次随访时ST的变化以及椎管形态的改变,并于术前及末次随访时通过SRS问卷对患者生活质量进行评估。结果:所有患者均获得随访,随访时间12~36个月(22.0±8.5个月),随访期内所有病例均未出现内固定失败。术前GK为59.9°±21.0°、TLK为38.0°±13.0°、LL为7.4°±26.5°、SVA为27.2±8.6mm,术后末次随访时GK为15.7°±2.1°、TLK为5.6°±2.6°、LL为-36.1°±2.9°、SVA为6.1±4.3mm,末次随访时所有患者ST均有改善,ST由术后7.1±2.7mm减小为末次随访时的1.2±1.0mm,差异有统计学意义(P0.05),ST变化率为(84.9±9.7)%。4例患者出现神经并发症。SRS满意度调查术前评分为1.6±0.3分,末次随访时评分为4.7±0.4分,差异有统计学意义(P0.05)。末次随访时截骨节段的椎管形态均有不同程度的自发重塑形。结论:AS脊柱胸腰段后凸畸形截骨术发生ST的患者术后均会发生不同程度的椎管自发重塑形,经过重塑形ST均不同程度的减小甚至消失。
[Abstract]:Objective: to observe the changes of spinal canal morphology and spontaneous remodeling of spinal canal in patients with ankylosing spondylitis ASA osteotomy with sagittal transposition (sagittal translation ST). Methods: sixteen patients with as thoracolumbar kyphosis who underwent transpedicular osteotomy in our hospital from January 2011 to December 2014 were retrospectively analyzed. There were 14 males and 2 females, aged 2855 years and 38.6 卤8.4 years old. Before and after operation and at the last follow-up, X-ray films and ST-segment 3D CT scans were taken of the whole spine in the natural standing position. The size of GKG, TLK, LLA, SVA and St were measured respectively in the total kyphoid angle, the thoracolumbar kyphoid angle, the sagittal deviation of SVA, and the size of St, respectively. The changes of St and the morphology of spinal canal were observed after operation and at the last follow-up. The quality of life was evaluated by SRS questionnaire before and after the last follow-up. Results: all the patients were followed up for 12 ~ 36 months (22. 0 卤8. 5 months). No failure of internal fixation occurred in all patients during the follow-up period. The preoperative GK was 59.9 掳卤21.0 掳TLK, 38.0 掳卤13.0 掳LL, 7.4 掳卤26.5 掳SVA, 27.2 卤8.6 mm, and 15.7 掳卤2.1 掳TLK, 5.6 掳卤2.6 掳TLK, 5.6 掳卤2.6 掳LL, -36.1 掳卤2.9 掳SVA, 6.1 卤4.3 mm, respectively. At the last follow-up, St was improved from 7.1 卤2.7mm to 1.2 卤1.0 mm at the last follow-up. The difference was significant (P 0.05). The preoperative score of neurologic complications. SRS satisfaction survey was 1.6 卤0.3. At the last follow-up, the score was 4.7 卤0.4, and the difference was statistically significant (P 0.05). At the last follow-up, the vertebral canal morphology of the osteotomy segment had different degree of spontaneous remodeling. Conclusion the patients with thoracolumbar kyphosis osteotomy as had different degree of spontaneal remodeling, and the St of all patients was decreased or even disappeared in different degree after the operation of thoracolumbar kyphosis.
【作者单位】：解放军总医院骨科;
【分类号】：R687.31

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