螺钉置入修复强直性脊柱炎并发重度车轮状后凸畸形:应力分布于多节段  

Screw placement in repair of ankylosing spondylitis complicated by severe wheel-like kyphosis: stress distribution in multiple segments

作　　者：马俊毅[1] 杨静[1] 马原[1] 田慧中[1] 

机构地区：[1]新疆医科大学第六附属医院脊柱外一科,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《中国组织工程研究》2015年第13期2069-2074,共6页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金资助项目(81360280);项目名称:强直性脊柱炎后凸后路VCR/VCD矫形有限元模拟研究~~

摘　　要：背景:强直性脊柱炎并发后凸畸形是病变后期出现的脊柱矢状面上的车轮状畸形,重度车轮状后凸畸形患者,行脊柱截骨矫形是惟一的治疗方法。对于强直性脊柱炎并发同时存在于胸段、胸腰段以及腰段重度车轮状后凸畸形的患者,单一部位截骨很难获得安全有效的矫形效果。目的:观察全脊柱截骨联合V形截骨螺钉置入内固定对强直性脊柱炎并发重度车轮状后凸畸形的矫正效果,并分析应力分布情况。方法:2003年5月至2012年10月新疆医科大学第六附属医院采用全脊柱截骨联合V形截骨、椎弓根螺钉置入内固定修复强直性脊柱炎并发同时存在重度胸段、胸腰段以及腰段后凸的车轮状畸形患者36例,均为男性。测量脊柱后凸角、颌眉角、C7铅垂线以评价矫正效果。结果与结论:治疗后1周全脊柱最大后凸Cobb角由治疗前的(89.6±9.8)°矫正到(32.2±6.7)°,与治疗前差异有显著性意义(P<0.05),平均矫正率64%;颌眉角平均矫正到9.6°(P<0.05),平均矫正率76%;C7铅垂线平均矫正到4.4 cm(P<0.05),平均矫正率81%。随访24-48个月,末次随访时上述指标与术后1周比较差异无显著性意义(P>0.05),X射线片显示所有患者内固定位置良好。提示对于强直性脊柱炎引起的重度车轮状后凸畸形患者,行全脊柱截骨联合V形截骨螺钉置入内固定治疗是一种安全、有效的方法,可较好地矫正脊柱矢状面曲度还能降低矢状面成角过度的风险,使应力分布于多节段,使脊髓短缩及硬膜皱折分布于相对较长的节段,避免在短节段内脊髓短缩和硬膜皱折过度而引起神经损伤。BACKGROUND：Kyphotic deformity in ankylosing spondylitis is the flexion deformity of spine sagittal plane in the late lesion. Spinal osteotomy is the only treatment method in patients with severe wheel-like kyphosis. For thoracic and thoracolumbar ankylosing spondylitis patients with lumbar severe wheel-like kyphosis, osteotomy at a single site cannot obtain safe and effective orthopedic effect. OBJECTIVE：To observe the orthopedic effect of total spine osteotomy combined with V-shaped osteotomy for correction of severe wheel-like kyphosis deformity due to ankylosing spondylitis, and to analyze stress distribution. METHODS：From May 2003 to October 2012, total spine osteotomy combined with V-shaped osteotomy and pedicle screw fixation were adopted for repair of concurrent thoracic, thoracolumbar and lumbar severe wheel-like kyphosis deformity due to ankylosing spondylitis in 36 male cases in the Sixth Affiliated Hospital of Xinjiang Medical University. Spinal convex angle, chin-brow vertical angle and C 7 plumb line were measured to evaluate orthopedic effect. RESULTS AND CONCLUSION：The whole spine convex Cobb angle was corrected from preoperatively （89.6±9.8）° to （32.2±6.7）° at 1 week after treatment, showing significant difference （P0.05）. Radiographs demonstrated that fixation position was good in al patients. These results confirmed that in patient with severe wheel-like kyphosis deformity due to ankylosing spondylitis, the application of total spine osteotomy combined with V-shaped osteotomy is a safe and effective method, can better correct the spinal sagittal curvature and reduce the risk of sagittal angle, result in the stress distribution in many segments and the shortening of the spine and epidural buckling in relatively long segment, can avoid nerve damage induced by spinal cord shortening and epidural excessive buckling within short segment.

关 键 词：植入物 脊柱植入物 强直性脊柱炎 后凸畸形 全脊柱截骨 V形截骨 螺钉置入 国家自然科学基金 

分 类 号：R318[医药卫生—生物医学工程]