不同截骨术式对强直性脊柱炎后凸畸形患者矢状位平衡重建的影响

发布时间：2019-01-07 09:30

【摘要】：目的探讨经椎弓根椎体截骨(PSO)及经关节突截骨(SPO)治疗强直性脊柱炎(AS)脊柱后凸畸形的疗效差异,并通过脊柱-骨盆参数的变化评价其矢状位平衡的重建效果。方法回顾性分析2011年6月至2015年8月于郑州大学第一附属医院行PSO、SPO手术治疗的21例强直性脊柱炎脊柱后凸畸形患者资料,根据其手术方式分为PSO组及SPO组,术前、术后及末次随访均拍摄站立位全脊柱正、侧位X线片,测量冠状面和矢状面参数:矢状面躯干偏移(SVA)、胸腰椎最大后凸角(GK)、胸椎后凸角(TK)、腰椎前凸角(LL)、骨盆倾斜角(PT)、骨盆投射角(PI)和骶骨倾斜角(SS),分别进行组内及组间参数对比分析。结果术前两组患者影像学参数比较,差异均无统计学意义(P0.05),术后两组患者影像学参数仅SVA的差异有统计学意义(P0.05),末次随访时两组患者影像学参数差异均无统计学意义(P0.05)。PSO组患者的GK由术前的(75.31±17.13)°下降至术后的(31.81±15.15)°,末次随访时为(36.72±15.16)°,SPO组患者的GK由术前的(65.21±21.43)°下降至术后的(25.60±16.22)°,末次随访时为(40.72±20.41)°。PSO组患者的SVA术前为(78.62±63.31)mm,术后为(-15.13±27.82)mm,末次随访时为(11.02±52.54)mm,SPO组患者的SVA术前为(54.23±77.61)mm,术后为(16.68±42.76)mm,末次随访时为(19.26±37.04)mm。结论 (1)PSO及SPO截骨方式均能有效重建强直性脊柱炎后凸畸形患者的矢状位平衡;(2)两种截骨方式的矢状位平衡参数SVA的矫形效果存在差异,PSO组患者的SVA术后易出现过度矫正,但可自发性改善。SPO较PSO更易发生远期后凸矫正角度的丢失。
[Abstract]:Objective to investigate the effect of transpedicular vertebral body osteotomy (PSO) and transarticular osteotomy (SPO) in the treatment of ankylosing spondylitis (AS) kyphosis, and to evaluate the effect of sagittal balance reconstruction through the changes of spinal and pelvis parameters in patients with ankylosing spondylitis (ankylosing spondylitis). Methods the data of 21 patients with ankylosing spondylitis scoliosis treated by PSO,SPO from June 2011 to August 2015 in the first affiliated Hospital of Zhengzhou University were analyzed retrospectively. The patients were divided into PSO group and SPO group. After operation and at the last follow-up, the standing position of the whole spine was taken by X-ray film, and the coronal and sagittal plane parameters were measured: sagittal torso offset (SVA), thoracolumbar maximum kyphosis angle (GK), thoracic spine kyphosis angle (TK), lumbar kyphosis angle (LL), Pelvic oblique angle (PT),) pelvic projection angle (PI) and sacral obliquity angle (SS),) were compared and analyzed within and between groups. Results there was no significant difference in imaging parameters between the two groups before operation (P0.05), but there was only significant difference in SVA between the two groups after operation (P0.05). There was no significant difference in imaging parameters between the two groups at the last follow-up (P0.05) GK in). PSO group decreased from (75.31 卤17.13) 掳before operation to (31.81 卤15.15) 掳after operation, and (36.72 卤15.16) 掳in the last follow-up. GK in SPO group decreased from (65.21 卤21.43) 掳before operation to (25.60 卤16.22) 掳after operation, and at the last follow-up it was (40.72 卤20.41) 掳in PSO group, and (78.62 卤63.31) mm, in PSO group. After (-15.13 卤27.82) mm, follow-up, SVA was (11.02 卤52.54) mm,SPO patients before and after (54.23 卤77.61) mm, (16.68 卤42.76) mm, and (19.26 卤37.04) mm. at the last follow-up. Conclusion (1) both PSO and SPO osteotomy can effectively reconstruct the sagittal balance of kyphosis in patients with ankylosing spondylitis. (2) the orthopedic effect of sagittal balance parameter SVA was different between the two osteotomy methods. In PSO group, excessive correction was easy to occur after SVA, but spontaneous improvement could be achieved. SPO was more prone to the loss of long-term kyphosis correction angle than PSO.
【作者单位】：郑州大学第一附属医院骨科;
【分类号】：R687.3

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