经椎弓根截骨对强直性脊柱炎胸腰椎后凸畸形脊柱-骨盆参数的影响

  目的 探讨经椎弓根椎体截骨(pedicle subtraction osteotomy, PSO)治疗强直性脊柱炎胸腰 椎后凸畸形术后脊柱-骨盆参数的变化及意义。 方法回顾性分析2006 年7月至2010 年10 月在我: 行L1 PSO矫形内固定术的21 例强直性脊柱炎胸腰椎后凸畸形患者。男18 例, 女3 例;年龄(35.6±10.8) 岁(21~53 岁)。所有患者手术前后均摄站立位全脊柱正、侧位X线片。统计测量所有患者的术前、术后即 刻X线片的胸椎后凸(thoracic kyphosis, TK)、腰椎前凸(lumbar lordosis, LL)、全脊柱最大后凸Cobb 角 (globe kyphosis, GK)、固定节段角度(angle of the fusion levels, AFL)、矢状面平衡(sagittal vertical axis, SVA)、骨盆投射角(pelvic incidence, PI)、骶骨倾斜角(sacral slope, SS)和骨盆倾斜角(pelvic tilting, PT)。 结果脊柱-骨盆相关参数中, 除TK 和PI 外, 其余参数手术前后相比较差异均有统计学意义(P < 0.01)。LL 的变化与PT(r=0.59, P=0.005)、SS(r=0.64, P=0.002)、SVA(r=0.49, P=0.025)及AFL(r=0.60, P= 0.004)的变化存在线性相关, PT的变化与SS(r=0.94, P=0.000)的变化存在线性相关, AFL的变化与PT (r=0.59, P=0.005)、SS(r=0.61, P=0.003)的变化存在线性相关。 结论 PSO能够显著地改善强直性脊柱炎 胸腰椎后凸畸形患者脊柱-骨盆矢状面形态;LL的重建与骨盆矢状面形态的改变密切相关。

Effect of pedicle subtraction osteotomy on spino-pelvic parameters in ankylosing spondylitis patients with thoracolumbar kyphosis

Objective To explore the change of spino-pelvic parameters following pedicle subtraction osteotomy (PSO) for thoracolumbar kyphosis secondary to ankylosing spondylitis(AS). Methods Twentyone AS patients with thoracolumbar kyphosis, who underwent PSO at L1 level from July 2006 to October 2010 in our hospital, were retrospectively reviewed. There were 18 males and 3 females with a mean age of 35.6 years (range, 21-53 years). The pre-and post-operative thoracic kyphosis (TK), lumbar lordosis (LL), globe kyphosis (GK), angle of the fusion levels (AFL), sagittal imbalance (SVA), pelvic incidence (PI), sacral slope (SS) and pelvic tilting (PT) were measured. Results Significant differences were observed in terms of the improvement of LL, PT, SS, SVA, GK and AFL (P < 0.01). The alteration of LL showed significant correlation with the change of PT (r=0.59, P=0.005), SS (r=0.64, P=0.002), SVA (r=0.49, P=0.025), and AFL (r= 0.60, P=0.004). The change of PT exhibited cardinal correlation with the change of SS(r=0.94, P=0.000). The improvement of AFL significantly correlated with the improvement of SS (r=0.61, P=0.003), PT (r=0.59, P= 0.005). Conclusion The change of the sagittal spino-pelvic profile following PSO in AS-related thoracolumbar kyphosis is closely related with the improvement of LL.