經椎弓根截骨術治療強直性脊柱炎后凸畸形_《中國修復重建外科雜志》

作者：

徐輝 , 張永剛 , 毛克亞 , 張雪松 , 王征 , 鄭國權 , 王巖

解放軍總醫院骨科（北京，100853）;

關鍵詞：

強直性脊柱炎后凸畸形經椎弓根截骨術腰椎

DOI：

10.7507/1002-1892.20130092

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目的探討腰椎單節段經椎弓根截骨術治療強直性脊柱炎后凸畸形的臨床效果。方法 2006年7 月－2010年7月，采用腰椎單節段經椎弓根截骨術治療強直性脊柱炎后凸畸形患者45例。其中男39例，女6例；年齡21～59歲，平均36.9歲。病程6～40年，平均18.6年。患者均表現為不同程度腰部酸痛、疲勞感，步態異常，平視及平臥功能障礙。術前影像學表現為骶髂關節融合，脊柱竹節樣改變，骨盆后傾，脊柱后凸畸形。病變累及頸椎者30例，局限于胸腰椎者15例。結果術后發生切口積液裂開1例，給予清創后愈合；其余患者切口均Ⅰ期愈合。術后發生腹部皮膚水皰2例，給予硫酸鎂濕敷后痊愈。42例患者獲隨訪，隨訪時間24～74個月，平均30個月。均達骨性融合，融合時間3～12個月，平均6.8個月。術后患者均能平視、直立行走及平臥。術后1周及末次隨訪時的胸腰段全長（T1～S1）Cobb角、腰段（L1～S1）Cobb角、頜眉角、矢狀面失平衡距離、脊柱側凸研究學會患者22項問卷量表（SRS-22）評分均較術前顯著改善，差異有統計學意義（P lt; 0.05）；各指標術后1周和末次隨訪時比較差異均無統計學意義（P gt; 0.05）。結論單節段經椎弓根腰椎截骨術矯正強直性脊柱炎后凸畸形臨床效果滿意。

引用本文： 徐輝,張永剛,毛克亞,張雪松,王征,鄭國權,王巖. 經椎弓根截骨術治療強直性脊柱炎后凸畸形. 中國修復重建外科雜志, 2013, 27(4): 389-392. doi: 10.7507/1002-1892.20130092 復制

1.	Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg (Am), 2004, 86(1): 44-50.
2.	Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg (Am), 2008, 90(11): 2509-2520.
3.	Kiaer T, Gehrchen M. Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J, 2010, 19(1): 57-64.
4.	Berven SH, Deviren V, Smith JA, et al. Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine (Phila Pa 1976), 2001, 26(18): 2036-2043.
5.	Kim KT, Suk KS, Cho YJ, et al. Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976), 2002, 27(6): 612-618.
6.	Kim KT, Lee SH, Suk KS, et al. Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine (Phila Pa 1976), 2012, 37(19): 1667-1675.
7.	Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg (Am), 1945, 27(1): 1-11.
8.	Hehne HJ, Zielke K, Böhm H. Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases. Clin Orthop Relat Res, 1990, (258): 49-55.
9.	Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J, 2011, 20(12): 2252-2260.
10.	Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
11.	Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
12.	Qian BP, Wang XH, Qiu Y, et al. The influence of closing-opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine (Phila Pa 1976), 2012, 37(16): 1415-1423.
13.	Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between Smith-Petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2012 , 25(7): 383-390.
14.	毛克亞, 王巖, 張永剛, 等. 經椎弓根楔形截骨矯正強直性脊柱炎后凸畸形. 脊柱外科雜志, 2007, 5(2): 85-87.
15.	王巖, 毛克亞, 張永剛, 等. 雙椎體截骨術矯正重度強直性脊柱炎后凸畸形. 中國脊柱脊髓雜志, 2009, 19(2): 108-112.
16.	Suk KS, Kim KT, Lee SH, et al. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976), 2003, 28(17): 2001-2005.
17.	Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
18.	van Loon PJ, van Stralen G, van Loon CJ, et al. Pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report. Spine J, 2006, 6(2): 195-200.
19.	Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976), 2007, 32(20): 2189-2197.
20.	Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
21.	Bridwell KH, Lewis SJ, Edwards C, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976), 28(18): 2093-2101.

1. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg (Am), 2004, 86(1): 44-50.
2. Gill JB, Levin A, Burd T, et al. Corrective osteotomies in spine surgery. J Bone Joint Surg (Am), 2008, 90(11): 2509-2520.
3. Kiaer T, Gehrchen M. Transpedicular closed wedge osteotomy in ankylosing spondylitis: results of surgical treatment and prospective outcome analysis. Eur Spine J, 2010, 19(1): 57-64.
4. Berven SH, Deviren V, Smith JA, et al. Management of fixed sagittal plane deformity: results of the transpedicular wedge resection osteotomy. Spine (Phila Pa 1976), 2001, 26(18): 2036-2043.
5. Kim KT, Suk KS, Cho YJ, et al. Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine (Phila Pa 1976), 2002, 27(6): 612-618.
6. Kim KT, Lee SH, Suk KS, et al. Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine (Phila Pa 1976), 2012, 37(19): 1667-1675.
7. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg (Am), 1945, 27(1): 1-11.
8. Hehne HJ, Zielke K, Böhm H. Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases. Clin Orthop Relat Res, 1990, (258): 49-55.
9. Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique for instrumented reduction. Eur Spine J, 2011, 20(12): 2252-2260.
10. Cho KJ, Bridwell KH, Lenke LG, et al. Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976), 2005, 30(18): 2030-2037.
11. Thomasen E. Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res, 1985, (194): 142-152.
12. Qian BP, Wang XH, Qiu Y, et al. The influence of closing-opening wedge osteotomy on sagittal balance in thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison with closing wedge osteotomy. Spine (Phila Pa 1976), 2012, 37(16): 1415-1423.
13. Zhu Z, Wang X, Qian B, et al. Loss of correction in the treatment of thoracolumbar kyphosis secondary to ankylosing spondylitis: a comparison between Smith-Petersen osteotomies and pedicle subtraction osteotomy. J Spinal Disord Tech, 2012 , 25(7): 383-390.
14. 毛克亞, 王巖, 張永剛, 等. 經椎弓根楔形截骨矯正強直性脊柱炎后凸畸形. 脊柱外科雜志, 2007, 5(2): 85-87.
15. 王巖, 毛克亞, 張永剛, 等. 雙椎體截骨術矯正重度強直性脊柱炎后凸畸形. 中國脊柱脊髓雜志, 2009, 19(2): 108-112.
16. Suk KS, Kim KT, Lee SH, et al. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine (Phila Pa 1976), 2003, 28(17): 2001-2005.
17. Debarge R, Demey G, Roussouly P. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis. Eur Spine J, 2011, 20 Suppl 5: 619-625.
18. van Loon PJ, van Stralen G, van Loon CJ, et al. Pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report. Spine J, 2006, 6(2): 195-200.
19. Kim YJ, Bridwell KH, Lenke LG, et al. Results of lumbar pedicle subtraction osteotomies for fixed sagittal imbalance: a minimum 5-year follow-up study. Spine (Phila Pa 1976), 2007, 32(20): 2189-2197.
20. Debarge R, Demey G, Roussouly P. Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy. Eur Spine J, 2010, 19(1): 65-70.
21. Bridwell KH, Lewis SJ, Edwards C, et al. Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine (Phila Pa 1976), 28(18): 2093-2101.

《中國修復重建外科雜志》

經椎弓根截骨術治療強直性脊柱炎后凸畸形

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《中國修復重建外科雜志》

經椎弓根截骨術治療強直性脊柱炎后凸畸形

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