CAJ | 학술논문

背景：强直性脊柱炎并发后凸畸形是病变后期出现的脊柱矢状面上的车轮状畸形，重度车轮状后凸畸形患者，行脊柱截骨矫形是惟一的治疗方法。对于强直性脊柱炎并发同时存在于胸段、胸腰段以及腰段重度车轮状后凸畸形的患者，单一部位截骨很难获得安全有效的矫形效果。目的：观察全脊柱截骨联合V形截骨螺钉置入内固定对强直性脊柱炎并发重度车轮状后凸畸形的矫正效果，并分析应力分布情况。方法：2003年5月至2012年10月新疆医科大学第六附属医院采用全脊柱截骨联合V形截骨、椎弓根螺钉置入内固定修复强直性脊柱炎并发同时存在重度胸段、胸腰段以及腰段后凸的车轮状畸形患者36例，均为男性。测量脊柱后凸角、颌眉角、C7结果与结论：治疗后1周全脊柱最大后凸Cobb角由治疗前的(89.6±9.8)°矫正到(32.2±6.7)°，与治疗前差异有显著性意义(P<0.05)，平均矫正率64%；颌眉角平均矫正到9.6°(P<0.05)，平均矫正率76%；C铅垂线以评价矫正效果。7铅垂线平均矫正到4.4 cm(P<0.05)，平均矫正率81%。随访24-48个月，末次随访时上述指标与术后1周比较差异无显著性意义(P >0.05)，X射线片显示所有患者内固定位置良好。提示对于强直性脊柱炎引起的重度车轮状后凸畸形患者，行全脊柱截骨联合V形截骨螺钉置入内固定治疗是一种安全、有效的方法，可较好地矫正脊柱矢状面曲度还能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，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。
배경：강직성척주염병발후철기형시병변후기출현적척주시상면상적차륜상기형，중도차륜상후철기형환자，행척주절골교형시유일적치료방법。대우강직성척주염병발동시존재우흉단、흉요단이급요단중도차륜상후철기형적환자，단일부위절골흔난획득안전유효적교형효과。목적：관찰전척주절골연합V형절골라정치입내고정대강직성척주염병발중도차륜상후철기형적교정효과，병분석응력분포정황。방법：2003년5월지2012년10월신강의과대학제륙부속의원채용전척주절골연합V형절골、추궁근라정치입내고정수복강직성척주염병발동시존재중도흉단、흉요단이급요단후철적차륜상기형환자36례，균위남성。측량척주후철각、합미각、C7결과여결론：치료후1주전척주최대후철Cobb각유치료전적(89.6±9.8)°교정도(32.2±6.7)°，여치료전차이유현저성의의(P<0.05)，평균교정솔64%；합미각평균교정도9.6°(P<0.05)，평균교정솔76%；C연수선이평개교정효과。7연수선평균교정도4.4 cm(P<0.05)，평균교정솔81%。수방24-48개월，말차수방시상술지표여술후1주비교차이무현저성의의(P >0.05)，X사선편현시소유환자내고정위치량호。제시대우강직성척주염인기적중도차륜상후철기형환자，행전척주절골연합V형절골라정치입내고정치료시일충안전、유효적방법，가교호지교정척주시상면곡도환능강저시상면성각과도적풍험，사응력분포우다절단，사척수단축급경막추절분포우상대교장적절단，피면재단절단내척수단축화경막추절과도이인기신경손상。
BACKGROUND:Kyphotic deformity in ankylosing spondylitis is the flexion deformity of spine sagittal plane in the late lesion. Spinal osteotomy is the only treatment method in patients with severe wheel-like kyphosis. For thoracic and thoracolumbar ankylosing spondylitis patients with lumbar severe wheel-like kyphosis, osteotomy at a single site cannot obtain safe and effective orthopedic effect. OBJECTIVE:To observe the orthopedic effect of total spine osteotomy combined with V-shaped osteotomy for correction of severe wheel-like kyphosis deformity due to ankylosing spondylitis, and to analyze stress distribution. METHODS:From May 2003 to October 2012, total spine osteotomy combined with V-shaped osteotomy and pedicle screw fixation were adopted for repair of concurrent thoracic, thoracolumbar and lumbar severe wheel-like kyphosis deformity due to ankylosing spondylitis in 36 male cases in the Sixth Affiliated Hospital of Xinjiang Medical University. Spinal convex angle, chin-brow vertical angle and C 7 plumb line were measured to evaluate orthopedic effect. RESULTS AND CONCLUSION:The whole spine convex Cobb angle was corrected from preoperatively (89.6±9.8)° to (32.2±6.7)° at 1 week after treatment, showing significant difference (P<0.05), with an average correction rate of 64%. The chin-brow vertical angle was 9.6° averagely after correction (P<0.05), with an average correction rate of 76%. The C 7 plumb line was 4.4 cm averagely after correction (P<0.05), with an average correction rate of 81%. After fol ow-up of 24-48 months, no significant difference in above indexes was detected during final fol ow-up and 1 week postoperatively (P>0.05). Radiographs demonstrated that fixation position was good in al patients. These results confirmed that in patient with severe wheel-like kyphosis deformity due to ankylosing spondylitis, the application of total spine osteotomy combined with V-shaped osteotomy is a safe and effective method, can better correct the spinal sagittal curvature and reduce the risk of sagittal angle, result in the stress distribution in many segments and the shortening of the spine and epidural buckling in relatively long segment, can avoid nerve damage induced by spinal cord shortening and epidural excessive buckling within short segment.