【摘要】：目的：分析強直性脊柱炎并發(fā)脊柱矢狀面重度車輪狀后凸畸形患者行經(jīng)椎弓根椎體楔形截骨術聯(lián)合V形截骨術+長節(jié)段椎弓根螺釘內固定系統(tǒng)矯正的臨床效果。方法：2002年6月-2012年11月我院脊柱外科采用經(jīng)椎弓根椎體楔形截骨術聯(lián)合V形截骨術+長節(jié)段椎弓根螺釘內固定術矯正強直性脊柱炎并發(fā)脊柱矢狀面同時存在重度胸段、胸腰段以及腰段后凸的車輪狀畸形患者38例,均為男性,年齡22-56歲,平均36.3歲。測量脊柱后凸角、腰前凸、頜眉角、C7鉛垂線評價矯正效果,應用日本骨科學會JOA評分法進行療效評估,術前及末次隨訪患者ODI評分,評價患者的畸形矯正效果及患者的生活質量。結果：38例患者中36例獲得隨訪,1例患者術后7月死亡具體原因不詳,1例隨訪5月后失去聯(lián)系,GK由手術前的88.6°±9.8°(70°～110°)矯正到33.7°±7.2°(23°～50.1°),與術前比較差異有統(tǒng)計學意義(P0.05),平均矯正率64.3%；CBVA術前的平均68.2°±16.3°(46°～120°)矯正到10.4°±6.2°(5°～37.6°)(P0.05),平均矯正率76.5%；C7PL由術前的34.4±11.5(15～55)平均矯正到10.6±3(5.4～16.7)(P0.05),平均矯正率81.2%;隨訪24～48個月,平均33.5個月,末次隨訪時,與術后1周的GK、CBVA及C7PL比較差異無統(tǒng)計學意義(P0.05)。術前JOA：13.4±5.3分,術后JOA：23.7±3.3分；P0.05,兩組數(shù)據(jù)的差異有統(tǒng)計學意義,末次隨訪時JOA評分較前明顯提高。治療改善率為72.5+4.85,治療改善率優(yōu)：28例,良：5例,中：3例。ODI評分由術前31.6±9.5分,末次隨訪時改善至13.9±7.8分(P0.05),兩組數(shù)據(jù)的差異有統(tǒng)計學意義,療效滿意。全脊柱X線片示所有術后患者內固定位置良好,無斷釘、斷棒、拔出等現(xiàn)象。結論：對于AS重度車輪狀后凸的畸形患者,行經(jīng)椎弓根椎體截骨術聯(lián)合V形截骨治療是一種安全、有效的方法,可較好地矯正脊柱矢狀面曲度還可降低矢狀面成角過度的風險,使應力分布于多節(jié)段,使脊髓短縮及硬膜皺折分布于相對較長的節(jié)段,可避免在短節(jié)段內脊髓短縮和硬膜皺折過度而引起神經(jīng)損傷。
[Abstract]:Objective: to analyze the clinical effect of transpedicular wedge osteotomy combined with V-shaped osteotomy in patients with ankylosing spondylitis complicated with severe wheel kyphosis in sagittal plane. Methods: from June 2002 to November 2012, spinal wedge osteotomy combined with V-shaped osteotomy was used to treat ankylosing spondylitis complicated with spinal sagittal plane with severe thoracic segment. Thirty-eight patients with thoracolumbar and lumbar kyphosis were male, aged 22-56 years (mean 36.3 years). The correction effect was evaluated by measuring the kyphosis angle, lumbar kyphosis, maxillary eyebrow angle C7 vertical line. The curative effect was evaluated by JOA score of Japanese orthopedic society. The ODI score was evaluated before and after the last follow-up. To evaluate the effect of deformity correction and the quality of life of patients. Results 36 of 38 patients were followed up and 1 patient died 7 months after operation. One patient lost contact with GK from 88.6 擄鹵9.8 擄(70 擄/ 110 擄) to 33.7 擄鹵7.2 擄(23 擄/ 50.1 擄) after follow-up for 5 months. The average correction rate was 64.3 擄(P0.05). The average correction before CBVA was 68.2 擄鹵16.3 擄(46 擄/ 120 擄) to 10.4 擄鹵6.2 擄(5 擄/ 37.6 擄) (P0.05). The average correction rate of C7PL was 76.5 鹵11.5 (1555), 10.6 鹵3 (5.416.7) (P0.05), 81.2% (P 0.05). There was no significant difference between GK,CBVA and C7PL at 1 week after operation (P0.05). The scores of JOA:13.4 鹵5.3 before operation and JOA:23.7 鹵3.3 after operation were 0.05. The difference between the two groups was statistically significant. The JOA score of the last follow-up was significantly higher than that of the former. The improvement rate of treatment was 72.5 4.85, the improvement rate was excellent in 28 cases, good in 5 cases, middle in 3 cases. ODI score improved from 31.6 鹵9.5 points before operation to 13.9 鹵7.8 points at the last follow-up (P0.05). The difference between the two groups was statistically significant and the curative effect was satisfactory. X-ray films of the whole spine showed that all postoperative patients had good internal fixation, no broken nail, broken rod, pull-out and so on. Conclusion: transpedicular vertebra osteotomy combined with V-shaped osteotomy is a safe and effective method to correct the sagittal curvature of the spine and reduce the risk of excessive sagittal angle formation in AS patients with severe wheel kyphosis. The stress distribution in multiple segments and the distribution of spinal cord shortening and dural fold in relatively long segments can avoid the nerve injury caused by short contraction and excessive dural fold in the short segment.
【學位授予單位】：新疆醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
，

本文編號：2209432