CAJ | 학술논문

目的：探讨脊柱去松质骨化截骨术矫正强直性脊柱炎并脊柱后凸畸形的疗效。方法采用脊柱去松质骨化截骨术治疗28例强直性脊柱炎并脊柱后凸畸形患者。测量患者术前和术后的身高、颌眉角、矢状面失平衡距离和截骨部位后凸角，以评价疗效。结果手术时间128～226 min，术中出血量960～4580 ml。9例术中出现硬脊膜破裂，经严密缝合裂口并放置引流愈合；3例术后出现肺部感染，经积极抗感染治疗痊愈；4例发生应激性溃疡，经质子泵抑制剂治疗症状消失。患者身高由术前110.6～135.4（122.6±11.2）cm 矫正到术后150.6～175.8（160.8±9.66）cm，颌眉角由术前62°～112°（66°±26.3°）矫正到术后5.2°～21.4°（12.3°±6.2°），矢状面失平衡距离由术前12～28（16.6±4.6）cm 矫正到术后4.5～13.8（8.6±3.2）cm，Cobb角由术前40°～145°（86.2°±20.3°）后凸矫正到术后-19.2°～21.4°（-2.6°±16.1°）前凸，差异均有统计学意义（P＜0.05）。患者均获得随访，时间1～4（2.6±0.5）年。末次随访时，患者后凸畸形均明显改善。结论脊柱去松质骨化截骨术可以有效矫正强直性脊柱炎并脊柱后凸畸形，患者的外观和生活质量均可得到明显改善。
목적：탐토척주거송질골화절골술교정강직성척주염병척주후철기형적료효。방법채용척주거송질골화절골술치료28례강직성척주염병척주후철기형환자。측량환자술전화술후적신고、합미각、시상면실평형거리화절골부위후철각，이평개료효。결과수술시간128～226 min，술중출혈량960～4580 ml。9례술중출현경척막파렬，경엄밀봉합렬구병방치인류유합；3례술후출현폐부감염，경적겁항감염치료전유；4례발생응격성궤양，경질자빙억제제치료증상소실。환자신고유술전110.6～135.4（122.6±11.2）cm 교정도술후150.6～175.8（160.8±9.66）cm，합미각유술전62°～112°（66°±26.3°）교정도술후5.2°～21.4°（12.3°±6.2°），시상면실평형거리유술전12～28（16.6±4.6）cm 교정도술후4.5～13.8（8.6±3.2）cm，Cobb각유술전40°～145°（86.2°±20.3°）후철교정도술후-19.2°～21.4°（-2.6°±16.1°）전철，차이균유통계학의의（P＜0.05）。환자균획득수방，시간1～4（2.6±0.5）년。말차수방시，환자후철기형균명현개선。결론척주거송질골화절골술가이유효교정강직성척주염병척주후철기형，환자적외관화생활질량균가득도명현개선。
Objective To probe the clinical effect of the vertebral column decancellation(VCD)osteotomy for the management of the spinal kyphotic deformity due to ankylosing spondylitis.Methods Twenty-eight patients with spi-nal kyphotic deformity due to ankylosing spondylitis underwent VCD osteotomy.Preoperative and postoperative height,brow-chin angle,distance of sagittal balance loss and Cobb angle of the osteotomy sites were measured to e-valuate the curative effect.Results The operation time was 128~226 minutes,and the intraoperative blood loss was 960~4 580 ml.Dural rupture encountered in operation in 9 patients,and they healed on time by tight suture and drainage.Three patients encountered postoperative pulmonary infection,and recovered by positive anti-inflammatory therapy treatment.Four patients encountered stress gastric ulcer after operation,and recovered through the proton pump inhibitor treatment.The height was corrected from preoperative 1 10.6~135.4(122.6 ±1 1.2)cm to postopera-tive 150.6~175.8(160.8 ±9.66)cm.The brow-chin angle was corrected from preoperative 62°~112°(66°± 26.3°)to postoperative 5.2~21.4°(12.3°±6.2°).The distance of sagittal balance loss was corrected from preop-erative 12~28(16.6 ±4.6)cm to postoperative 4.5 ~13.8(8.6 ±3.2)cm.Cobb angle was corrected from preoper-ative 40°~145°(86.2°±20.3°)with kyphosis to postoperative -19.2°~21.4°(-2.6°±16.1°)with lordosis. The differences were statistically significant(P<0.05).All patients were followed up for 1 ~4(2.6 ±0.5)years. At final follow-up,all the spinal kyphotic deformities of the patients were corrected obviously.Conclusions VCD osteotomy can effectively correct spinal kyphotic deformity due to ankylosing spondylitis,and significantly improve the appearance and quality of life of patients.