经椎弓根截骨术治疗强直性脊柱炎后凸畸形_《中国修复重建外科杂志》

作者：

徐辉 , 张永刚 , 毛克亚 , 张雪松 , 王征 , 郑国权 , 王岩

解放军总医院骨科（北京，100853）;

关键词：

强直性脊柱炎后凸畸形经椎弓根截骨术腰椎

DOI：

10.7507/1002-1892.20130092

视频：

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目的探讨腰椎单节段经椎弓根截骨术治疗强直性脊柱炎后凸畸形的临床效果。方法 2006年7 月－2010年7月，采用腰椎单节段经椎弓根截骨术治疗强直性脊柱炎后凸畸形患者45例。其中男39例，女6例；年龄21～59岁，平均36.9岁。病程6～40年，平均18.6年。患者均表现为不同程度腰部酸痛、疲劳感，步态异常，平视及平卧功能障碍。术前影像学表现为骶髂关节融合，脊柱竹节样改变，骨盆后倾，脊柱后凸畸形。病变累及颈椎者30例，局限于胸腰椎者15例。结果术后发生切口积液裂开1例，给予清创后愈合；其余患者切口均Ⅰ期愈合。术后发生腹部皮肤水疱2例，给予硫酸镁湿敷后痊愈。42例患者获随访，随访时间24～74个月，平均30个月。均达骨性融合，融合时间3～12个月，平均6.8个月。术后患者均能平视、直立行走及平卧。术后1周及末次随访时的胸腰段全长（T1～S1）Cobb角、腰段（L1～S1）Cobb角、颌眉角、矢状面失平衡距离、脊柱侧凸研究学会患者22项问卷量表（SRS-22）评分均较术前显著改善，差异有统计学意义（P lt; 0.05）；各指标术后1周和末次随访时比较差异均无统计学意义（P gt; 0.05）。结论单节段经椎弓根腰椎截骨术矫正强直性脊柱炎后凸畸形临床效果满意。

引用本文： 徐辉,张永刚,毛克亚,张雪松,王征,郑国权,王岩. 经椎弓根截骨术治疗强直性脊柱炎后凸畸形. 中国修复重建外科杂志, 2013, 27(4): 389-392. doi: 10.7507/1002-1892.20130092 复制

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.	毛克亚, 王岩, 张永刚, 等. 经椎弓根楔形截骨矫正强直性脊柱炎后凸畸形. 脊柱外科杂志, 2007, 5(2): 85-87.
15.	王岩, 毛克亚, 张永刚, 等. 双椎体截骨术矫正重度强直性脊柱炎后凸畸形. 中国脊柱脊髓杂志, 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. 毛克亚, 王岩, 张永刚, 等. 经椎弓根楔形截骨矫正强直性脊柱炎后凸畸形. 脊柱外科杂志, 2007, 5(2): 85-87.
15. 王岩, 毛克亚, 张永刚, 等. 双椎体截骨术矫正重度强直性脊柱炎后凸畸形. 中国脊柱脊髓杂志, 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.

《中国修复重建外科杂志》

经椎弓根截骨术治疗强直性脊柱炎后凸畸形

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《中国修复重建外科杂志》

经椎弓根截骨术治疗强直性脊柱炎后凸畸形

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