经椎弓根不对称截骨重建强直性脊柱炎胸腰椎侧后凸畸形患者双平面平衡

 目的 探讨经椎弓根不对称截骨（asymmetrical pedicle subtraction osteotomy, APSO）在强直性脊柱炎（ankylosing spondylitis, AS）胸腰椎侧后凸畸形患者冠状面和矢状面平衡重建中的作用。方法 回顾性分析2005年10月至2012年6月采用APSO手术治疗16例AS胸腰椎侧后凸畸形患者资料,男13例,女3例;年龄22~48岁,平均35.4岁。术前、术后及末次随访均摄站立位全脊柱正、侧位X线片,测量冠状面和矢状面参数：冠状面Cobb角,冠状面躯干偏移（central sacral vertical line,CSVL）、胸腰椎最大后凸角（global kyphosis,GK）、矢状面躯干偏移（sagittal vertical axis,SVA)、胸椎后凸角（thoracic kyphosis,TK)、腰椎前凸角（lumbar lordosis,LL）、骨盆倾斜角（pelvic tilt,PT）、骶骨倾斜角（sacral slope,SS）和骨盆投射角（pelvic incidence,PI）。采用SF-36量表评估AS胸腰椎侧后凸畸形患者术前和末次随访的生活质量。结果 随访时间24~63个月。冠状面Cobb角由术前25.8°矫正至术后7.6°,矫正率70.5%;CSVL由术前5.6 cm矫正至术后1.8 cm;GK由术前76.8°矫正至术后25.6°,矫正率66.7%;SVA由术前15.1 cm矫正至术后3.8 cm。LL、PT和SS分别由术前的-0.4°、33.6°和10.3°矫正至术后44.1°、22.6°和20.9°,差异均有统计学意义。末次随访时,冠状面Cobb角、CSVL、GK、SVA、LL、PT和SS出现轻度矫正丢失。末次随访时AS患者躯体疼痛、一般健康状况、社会功能和情感职能评分均获得明显提高。结论 AS胸腰椎侧后凸畸形患者同时伴有冠状面和矢状面失平衡,导致其生活质量严重降低。APSO手术在矫正其矢状面失平衡的同时,还可明显改善冠状面躯干失平衡,可实现满意的双平面重建;患者生活质量较术前也获得明显提高。

Analysis of the surgical outcome of asymmetrical pedicle subtraction osteotomy in ankylosing spondylitis patients with thoracolumbar kyphoscoliotic deformity

Objective To investigate the influence of asymmetrical pedicle subtraction osteotomy (APSO) on the reconstruction of coronal and sagittal balance in ankylosing spondylitis (AS) patients with thoracolumbar kyphoscoliotic deformity. Methods Between October 2005 and June 2012, sixteen AS patients (13 males and 3 females) with a mean age of 35.4 years (range, 22-48 years) with thoracolumbar kyphoscoliotic deformity undergoing APSO were included in this study. Preoperative, postoperative and last follow-up full-length antero-posterior and lateral spine radiographs were available. Coronal and sagittal parameters were measured, including Cobb angle, central sacral vertical line (CSVL), global kyphosis (GK), sagittal vertical axis (SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), and pelvic incidence (PI). SF-36 questionnaire was used to evaluate the quality of life of AS patients. The preoperative and postoperative data were compared by paired sample t test. Results The average time of follow-up was 36 months (range, 24-63 months). The mean Cobb angle was improved from 25.8°to 7.6°, and the correction rate was 70.5%. The CSVL was corrected from 5.6 cm to 1.8 cm. The mean GK was corrected from 76.8° to 25.6°, and the correction rate was 66.7%. The SVA was restored from 15.1 cm to 3.8 cm. In addition, LL, PT, and SS were improved from -0.4°, 33.6°, and 10.3° to 44.1°, 22.6°, and 20.9°, respectively. In terms of Cobb angle, CSVL, GK, SVA, LL, PT, and SS, no significant differences were observed. The scores of bodily pain, general health, social and emotional functioning were significantly increased at the last follow-up. Conclusion AS patients with thoracolumbar kyphoscoliotic deformity have both sagittal and coronal imbalance with impairment in quality of life. APSO can achieve successful realignment of biplanar balance by correcting thoracolumbar kyphosis and scoliosis simultaneously, and improve the quality of life in AS patients with kyphoscoliotic deformity.