CAJ | 학술논문

目的评估后路联合经椎弓根椎体间截骨手术(PSO)和椎板关节突V形截骨术矫正强直性脊柱炎(AS)合并重度胸腰椎后凸畸形的临床疗效.方法 2004年8月至2007年6月,共收治AS合并重度胸腰椎后凸畸形患者8例,均为男性,年龄28～46岁,平均32岁;平均胸椎后凸角度(T1～T12)96°(80°～112°),腰椎前凸角度(L1～S1)平均10°(5°～15°),平均颏眉角47°(40°～58°),平均注视角43°(32°～50°).8例患者均在L3椎体行PSO术并在胸腰段(T12～L1,L1-2)之间进行椎板关节突V形截骨.术后综合评估影像学、临床疗效以及并发症的情况.结果 8例患者平均手术时间(298.1±20.7)min,术中失血量(1588.8±171.6)ml.8例患者均获随访,随访时间为(11.5±7.7)个月.术后平均胸椎Cobb角76.1°±9.6°,矫正20.3°±1.1°;术后平均腰椎前凸角48.4°±4.7°,矫正38.4°±4.7°.术后平均颏眉角16.5°±4.6°,注视角73.0°±5.2°.矢状面平衡矫正(12.3±1.6)cm.无血管、神经损伤、应力性骨折等重大并发症发生,术后未发生冠状面的失代偿.结论后路联合单节段PSO联合双节段楔形截骨术矫正As合并重度后凸畸形效果安全可靠,可明显改善患者视野范围.
목적 평고후로연합경추궁근추체간절골수술(PSO)화추판관절돌V형절골술교정강직성척주염(AS)합병중도흉요추후철기형적림상료효.방법 2004년8월지2007년6월,공수치AS합병중도흉요추후철기형환자8례,균위남성,년령28～46세,평균32세;평균흉추후철각도(T1～T12)96°(80°～112°),요추전철각도(L1～S1)평균10°(5°～15°),평균해미각47°(40°～58°),평균주시각43°(32°～50°).8례환자균재L3추체행PSO술병재흉요단(T12～L1,L1-2)지간진행추판관절돌V형절골.술후종합평고영상학、림상료효이급병발증적정황.결과 8례환자평균수술시간(298.1±20.7)min,술중실혈량(1588.8±171.6)ml.8례환자균획수방,수방시간위(11.5±7.7)개월.술후평균흉추Cobb각76.1°±9.6°,교정20.3°±1.1°;술후평균요추전철각48.4°±4.7°,교정38.4°±4.7°.술후평균해미각16.5°±4.6°,주시각73.0°±5.2°.시상면평형교정(12.3±1.6)cm.무혈관、신경손상、응력성골절등중대병발증발생,술후미발생관상면적실대상.결론 후로연합단절단PSO연합쌍절단설형절골술교정As합병중도후철기형효과안전가고,가명현개선환자시야범위.
Objective To study retrospectively the efficacy and complications of combined pedicle subtraction osteotomy(PSO) and polysegmental closing wedge osteotomy for correction of the severe rigid thoracolumbar kyphotie deformity in ankylosing spondylitis (AS). Methods A total of 8 consecutive male patients with AS and severe thoracolumbar kyphotic deformity (mean age 32 years, range 28-46) were involved in this study from August 2004 to June 2007. The average preoperative Cobb angle of thoracic spine (T1-T12) was 96°(range, 80°-112°), the mean preoperative angle of lumbar lordosis (L1-S1) was 10°(5°-15°). The mean chin-brow angle was 47°(range, 40°-58°). The average gaze angle was 43°(range, 32°-50°). After preoperative assessment, single-level PSO was performed in L3 vertebrae and two-level polysegmental closing wedge osteotomy was performed in thoracolumbar vertebrae (T12-L1, L1-2). Radiographic and clinical results and complications were assessed. Results The surgical time was (298.1±20.7) minutes and blood loss during the procedure was (1588.8±171.6) ml. The follow-up period was (11.5±7.7) months. The postoperative angle and the amount of correction of the thoracic and lumbar spine were 76.1°±9.6°, 20.3°±1.1° and 48.4°±4.7°, 38.4~±4.7°respectively. The postoperative chin-brow and gaze angle was 16.5°±4.6° and 73.0°±5.2°, respectively. The amount of correction for sagittal balance was (12.3±1.6) cm. No nerve, vascular injury,stress fracture and coronal decompensation occurred in the patients. Conclusions Combined PSO and pelysegmental closing wedge osteotomy by posterior approach only is safe and effective for correction of the severe rigid thoracolumbar kyphotic deformity in AS. The visual field is significantly improved after surgery.