CAJ | 학술논문

目的：对强直性脊柱炎( ankylosing spondylitis，AS )后凸畸形个性化矫形后生活质量评分的进行相关性研究。方法2007年1月至2011年11月，共有40例无脊髓神经症状体征、双髋活动良好的 AS 后凸畸形患者纳入本研究，采用随机数字表法将40例患者分为 A、B 两组，均行后路经椎弓根单节段或双节段楔形闭合截骨矫形椎弓根螺钉内固定术，A 组采用个性化截骨方案，B 组采用传统截骨方案。记录 AS 患者矫形前后骨盆入射角( pelvic incidence，PI )，骨盆倾斜角( pelvic tilt，PT )，术前及术后6个月脊柱侧凸研究学会( scoliosis research society，SRS )-22评分、Oswestry 功能障碍指数( oswestry disability index，ODI )。分析矫形前后主观评分变化及矫形后 PI、PT 变量关系。结果 A、B 两组术前 PI、PT 值、ODI 指数及 SRS-22评分相比差异无统计学意义(P＞0.01)，术后 A、B 两组患者外观、心理、疼痛、功能及满意度均趋于正常，且 ODI 指数较术前明显改善，A、B 两组术后 SRS-外观评分分别为(4.6±0.3)、(4.3±0.3)，差异有统计学意义(P＜0.01)，SRS-心理、疼痛、功能、满意度差异无统计学意义(P＞0.01)，A、B 两组术后 ODI 指数差异无统计学意义(P＞0.01)。结论个性化矫形对 AS 患者术后生活质量有着较好的改善，同时，对颌眉角的纠正也具有更好的可控性。熟练掌握个性化矫形方法后，可以明显简化手术方案的讨论与争议，并能达到与传统截骨方案相似甚至更好的效果。
목적：대강직성척주염( ankylosing spondylitis，AS )후철기형개성화교형후생활질량평분적진행상관성연구。방법2007년1월지2011년11월，공유40례무척수신경증상체정、쌍관활동량호적 AS 후철기형환자납입본연구，채용수궤수자표법장40례환자분위 A、B 량조，균행후로경추궁근단절단혹쌍절단설형폐합절골교형추궁근라정내고정술，A 조채용개성화절골방안，B 조채용전통절골방안。기록 AS 환자교형전후골분입사각( pelvic incidence，PI )，골분경사각( pelvic tilt，PT )，술전급술후6개월척주측철연구학회( scoliosis research society，SRS )-22평분、Oswestry 공능장애지수( oswestry disability index，ODI )。분석교형전후주관평분변화급교형후 PI、PT 변량관계。결과 A、B 량조술전 PI、PT 치、ODI 지수급 SRS-22평분상비차이무통계학의의(P＞0.01)，술후 A、B 량조환자외관、심리、동통、공능급만의도균추우정상，차 ODI 지수교술전명현개선，A、B 량조술후 SRS-외관평분분별위(4.6±0.3)、(4.3±0.3)，차이유통계학의의(P＜0.01)，SRS-심리、동통、공능、만의도차이무통계학의의(P＞0.01)，A、B 량조술후 ODI 지수차이무통계학의의(P＞0.01)。결론개성화교형대 AS 환자술후생활질량유착교호적개선，동시，대합미각적규정야구유경호적가공성。숙련장악개성화교형방법후，가이명현간화수술방안적토론여쟁의，병능체도여전통절골방안상사심지경호적효과。
Objective To investigate health-related quality of life ( HRQOL ) after personalized kyphosis correction in ankylosing spondylitis ( AS ).Methods Forty AS patients with fixed thoracolumbar kyphosis were treated with pedicle subtraction osteotomies ( PSO ) in our hospital from January 2007 to November 2011. All patients with no spinal cord neurological signs and good hip range of motion in both sides were divided into two groups under randomized method. Closing wedge osteotomy correction and pedical screw fixation of single segment or double segments from posterior approach were performed in both groups. Group A was treated with personalized PSO and group B was treated with traditional PSO. Pre- and post-operative pelvic incidence ( PI ), pelvic tilt ( PT ) were measured. The scoliosis research society-22 ( SRS-22 ) questionnaire and Oswestry disability index ( ODI ) were used to evaluate clinical results. Analyses of assessing scores and the relationship between PI and PT preoperatively and postoperatively were conducted.Results There were no signiifcant differences between group A and group B in pre-operative PI, PT, ODI and SRS-22 (P>0.01 ). All of the patients experienced improvement in appearance, psychology, pain, function and satisfaction, especially ODI. There were no signiifcant differences between A and B in post-operative ODI, SRS-psychology, pain, function and satisfaction (P>0.01 ) but SRS-appearance (P=0.0020 ), which were ( 4.6±0.3 ), ( 4.3±0.3 ) respectively.Conclusions Personalized kyphosis correction can improve the quality of life for AS patients after the operation. It also has better controllability on the correct angle of the chin-brow. Mastering of the personalized method can signiifcantly simplify discussions and controversies of the operation plan to achieve similar even better effects compared with traditional method.