经椎弓根椎体截骨联合V形截骨矫正AS重度车轮状后凸畸形临床分析
发布时间：2018-08-28 12:42
【摘要】：目的：分析强直性脊柱炎并发脊柱矢状面重度车轮状后凸畸形患者行经椎弓根椎体楔形截骨术联合V形截骨术+长节段椎弓根螺钉内固定系统矫正的临床效果。方法：2002年6月-2012年11月我院脊柱外科采用经椎弓根椎体楔形截骨术联合V形截骨术+长节段椎弓根螺钉内固定术矫正强直性脊柱炎并发脊柱矢状面同时存在重度胸段、胸腰段以及腰段后凸的车轮状畸形患者38例,均为男性,年龄22-56岁,平均36.3岁。测量脊柱后凸角、腰前凸、颌眉角、C7铅垂线评价矫正效果,应用日本骨科学会JOA评分法进行疗效评估,术前及末次随访患者ODI评分,评价患者的畸形矫正效果及患者的生活质量。结果：38例患者中36例获得随访,1例患者术后7月死亡具体原因不详,1例随访5月后失去联系,GK由手术前的88.6°±9.8°(70°～110°)矫正到33.7°±7.2°(23°～50.1°),与术前比较差异有统计学意义(P0.05),平均矫正率64.3%；CBVA术前的平均68.2°±16.3°(46°～120°)矫正到10.4°±6.2°(5°～37.6°)(P0.05),平均矫正率76.5%；C7PL由术前的34.4±11.5(15～55)平均矫正到10.6±3(5.4～16.7)(P0.05),平均矫正率81.2%;随访24～48个月,平均33.5个月,末次随访时,与术后1周的GK、CBVA及C7PL比较差异无统计学意义(P0.05)。术前JOA：13.4±5.3分,术后JOA：23.7±3.3分；P0.05,两组数据的差异有统计学意义,末次随访时JOA评分较前明显提高。治疗改善率为72.5+4.85,治疗改善率优：28例,良：5例,中：3例。ODI评分由术前31.6±9.5分,末次随访时改善至13.9±7.8分(P0.05),两组数据的差异有统计学意义,疗效满意。全脊柱X线片示所有术后患者内固定位置良好,无断钉、断棒、拔出等现象。结论：对于AS重度车轮状后凸的畸形患者,行经椎弓根椎体截骨术联合V形截骨治疗是一种安全、有效的方法,可较好地矫正脊柱矢状面曲度还可降低矢状面成角过度的风险,使应力分布于多节段,使脊髓短缩及硬膜皱折分布于相对较长的节段,可避免在短节段内脊髓短缩和硬膜皱折过度而引起神经损伤。
[Abstract]:Objective: to analyze the clinical effect of transpedicular wedge osteotomy combined with V-shaped osteotomy in patients with ankylosing spondylitis complicated with severe wheel kyphosis in sagittal plane. Methods: from June 2002 to November 2012, spinal wedge osteotomy combined with V-shaped osteotomy was used to treat ankylosing spondylitis complicated with spinal sagittal plane with severe thoracic segment. Thirty-eight patients with thoracolumbar and lumbar kyphosis were male, aged 22-56 years (mean 36.3 years). The correction effect was evaluated by measuring the kyphosis angle, lumbar kyphosis, maxillary eyebrow angle C7 vertical line. The curative effect was evaluated by JOA score of Japanese orthopedic society. The ODI score was evaluated before and after the last follow-up. To evaluate the effect of deformity correction and the quality of life of patients. Results 36 of 38 patients were followed up and 1 patient died 7 months after operation. One patient lost contact with GK from 88.6 掳卤9.8 掳(70 掳/ 110 掳) to 33.7 掳卤7.2 掳(23 掳/ 50.1 掳) after follow-up for 5 months. The average correction rate was 64.3 掳(P0.05). The average correction before CBVA was 68.2 掳卤16.3 掳(46 掳/ 120 掳) to 10.4 掳卤6.2 掳(5 掳/ 37.6 掳) (P0.05). The average correction rate of C7PL was 76.5 卤11.5 (1555), 10.6 卤3 (5.416.7) (P0.05), 81.2% (P 0.05). There was no significant difference between GK,CBVA and C7PL at 1 week after operation (P0.05). The scores of JOA:13.4 卤5.3 before operation and JOA:23.7 卤3.3 after operation were 0.05. The difference between the two groups was statistically significant. The JOA score of the last follow-up was significantly higher than that of the former. The improvement rate of treatment was 72.5 4.85, the improvement rate was excellent in 28 cases, good in 5 cases, middle in 3 cases. ODI score improved from 31.6 卤9.5 points before operation to 13.9 卤7.8 points at the last follow-up (P0.05). The difference between the two groups was statistically significant and the curative effect was satisfactory. X-ray films of the whole spine showed that all postoperative patients had good internal fixation, no broken nail, broken rod, pull-out and so on. Conclusion: transpedicular vertebra osteotomy combined with V-shaped osteotomy is a safe and effective method to correct the sagittal curvature of the spine and reduce the risk of excessive sagittal angle formation in AS patients with severe wheel kyphosis. The stress distribution in multiple segments and the distribution of spinal cord shortening and dural fold in relatively long segments can avoid the nerve injury caused by short contraction and excessive dural fold in the short segment.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
，
本文编号：2209432
[Abstract]:Objective: to analyze the clinical effect of transpedicular wedge osteotomy combined with V-shaped osteotomy in patients with ankylosing spondylitis complicated with severe wheel kyphosis in sagittal plane. Methods: from June 2002 to November 2012, spinal wedge osteotomy combined with V-shaped osteotomy was used to treat ankylosing spondylitis complicated with spinal sagittal plane with severe thoracic segment. Thirty-eight patients with thoracolumbar and lumbar kyphosis were male, aged 22-56 years (mean 36.3 years). The correction effect was evaluated by measuring the kyphosis angle, lumbar kyphosis, maxillary eyebrow angle C7 vertical line. The curative effect was evaluated by JOA score of Japanese orthopedic society. The ODI score was evaluated before and after the last follow-up. To evaluate the effect of deformity correction and the quality of life of patients. Results 36 of 38 patients were followed up and 1 patient died 7 months after operation. One patient lost contact with GK from 88.6 掳卤9.8 掳(70 掳/ 110 掳) to 33.7 掳卤7.2 掳(23 掳/ 50.1 掳) after follow-up for 5 months. The average correction rate was 64.3 掳(P0.05). The average correction before CBVA was 68.2 掳卤16.3 掳(46 掳/ 120 掳) to 10.4 掳卤6.2 掳(5 掳/ 37.6 掳) (P0.05). The average correction rate of C7PL was 76.5 卤11.5 (1555), 10.6 卤3 (5.416.7) (P0.05), 81.2% (P 0.05). There was no significant difference between GK,CBVA and C7PL at 1 week after operation (P0.05). The scores of JOA:13.4 卤5.3 before operation and JOA:23.7 卤3.3 after operation were 0.05. The difference between the two groups was statistically significant. The JOA score of the last follow-up was significantly higher than that of the former. The improvement rate of treatment was 72.5 4.85, the improvement rate was excellent in 28 cases, good in 5 cases, middle in 3 cases. ODI score improved from 31.6 卤9.5 points before operation to 13.9 卤7.8 points at the last follow-up (P0.05). The difference between the two groups was statistically significant and the curative effect was satisfactory. X-ray films of the whole spine showed that all postoperative patients had good internal fixation, no broken nail, broken rod, pull-out and so on. Conclusion: transpedicular vertebra osteotomy combined with V-shaped osteotomy is a safe and effective method to correct the sagittal curvature of the spine and reduce the risk of excessive sagittal angle formation in AS patients with severe wheel kyphosis. The stress distribution in multiple segments and the distribution of spinal cord shortening and dural fold in relatively long segments can avoid the nerve injury caused by short contraction and excessive dural fold in the short segment.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
，
本文编号：2209432
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