本文選題：強(qiáng)直性脊柱炎 + 經(jīng)椎弓根截骨術(shù)　； 參考：《中國脊柱脊髓雜志》2017年02期

【摘要】：目的:觀察強(qiáng)直性脊柱炎(ankylosing spondylitis,AS)脊柱后凸畸形截骨術(shù)發(fā)生矢狀面移位(sagittal translation,ST)患者椎管形態(tài)的變化以及椎管自發(fā)重塑形現(xiàn)象。方法:回顧性分析2011年1月~2014年12月于我院行經(jīng)椎弓根截骨術(shù)發(fā)生ST的16例AS胸腰段脊柱后凸畸形患者,男14例,女2例,年齡28~55歲(38.6±8.4歲)。均于手術(shù)前后及末次隨訪時(shí)拍攝自然站立位全脊柱正側(cè)位X線片以及ST節(jié)段三維CT掃描,分別測(cè)量全脊柱后凸角(GK)、胸腰段后凸角(TLK)、腰前凸角(LL)、矢狀面偏移(SVA)以及ST的大小,觀察術(shù)后及末次隨訪時(shí)ST的變化以及椎管形態(tài)的改變,并于術(shù)前及末次隨訪時(shí)通過SRS問卷對(duì)患者生活質(zhì)量進(jìn)行評(píng)估。結(jié)果:所有患者均獲得隨訪,隨訪時(shí)間12~36個(gè)月(22.0±8.5個(gè)月),隨訪期內(nèi)所有病例均未出現(xiàn)內(nèi)固定失敗。術(shù)前GK為59.9°±21.0°、TLK為38.0°±13.0°、LL為7.4°±26.5°、SVA為27.2±8.6mm,術(shù)后末次隨訪時(shí)GK為15.7°±2.1°、TLK為5.6°±2.6°、LL為-36.1°±2.9°、SVA為6.1±4.3mm,末次隨訪時(shí)所有患者ST均有改善,ST由術(shù)后7.1±2.7mm減小為末次隨訪時(shí)的1.2±1.0mm,差異有統(tǒng)計(jì)學(xué)意義(P0.05),ST變化率為(84.9±9.7)%。4例患者出現(xiàn)神經(jīng)并發(fā)癥。SRS滿意度調(diào)查術(shù)前評(píng)分為1.6±0.3分,末次隨訪時(shí)評(píng)分為4.7±0.4分,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。末次隨訪時(shí)截骨節(jié)段的椎管形態(tài)均有不同程度的自發(fā)重塑形。結(jié)論:AS脊柱胸腰段后凸畸形截骨術(shù)發(fā)生ST的患者術(shù)后均會(huì)發(fā)生不同程度的椎管自發(fā)重塑形,經(jīng)過重塑形ST均不同程度的減小甚至消失。
[Abstract]:Objective: to observe the changes of spinal canal morphology and spontaneous remodeling of spinal canal in patients with ankylosing spondylitis ASA osteotomy with sagittal transposition (sagittal translation ST). Methods: sixteen patients with as thoracolumbar kyphosis who underwent transpedicular osteotomy in our hospital from January 2011 to December 2014 were retrospectively analyzed. There were 14 males and 2 females, aged 2855 years and 38.6 鹵8.4 years old. Before and after operation and at the last follow-up, X-ray films and ST-segment 3D CT scans were taken of the whole spine in the natural standing position. The size of GKG, TLK, LLA, SVA and St were measured respectively in the total kyphoid angle, the thoracolumbar kyphoid angle, the sagittal deviation of SVA, and the size of St, respectively. The changes of St and the morphology of spinal canal were observed after operation and at the last follow-up. The quality of life was evaluated by SRS questionnaire before and after the last follow-up. Results: all the patients were followed up for 12 ~ 36 months (22. 0 鹵8. 5 months). No failure of internal fixation occurred in all patients during the follow-up period. The preoperative GK was 59.9 擄鹵21.0 擄TLK, 38.0 擄鹵13.0 擄L(fēng)L, 7.4 擄鹵26.5 擄SVA, 27.2 鹵8.6 mm, and 15.7 擄鹵2.1 擄TLK, 5.6 擄鹵2.6 擄TLK, 5.6 擄鹵2.6 擄L(fēng)L, -36.1 擄鹵2.9 擄SVA, 6.1 鹵4.3 mm, respectively. At the last follow-up, St was improved from 7.1 鹵2.7mm to 1.2 鹵1.0 mm at the last follow-up. The difference was significant (P 0.05). The preoperative score of neurologic complications. SRS satisfaction survey was 1.6 鹵0.3. At the last follow-up, the score was 4.7 鹵0.4, and the difference was statistically significant (P 0.05). At the last follow-up, the vertebral canal morphology of the osteotomy segment had different degree of spontaneous remodeling. Conclusion the patients with thoracolumbar kyphosis osteotomy as had different degree of spontaneal remodeling, and the St of all patients was decreased or even disappeared in different degree after the operation of thoracolumbar kyphosis.
【作者單位】： 解放軍總醫(yī)院骨科;
【分類號(hào)】：R687.31

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本文編號(hào)：1988793