强直性脊柱炎后凸畸形患者经椎弓根椎体截骨术后心功能变化  

Cardiac function changes in patients with ankylosing spondylitis kyphosis after pedicle subtraction osteotomy

作　　者：付君[1] 张永刚[1] 王征[1] 宋凯[1] 刘超[1] 郑国权[1] 张国莹[1] 崔赓[1] 张雪松[1] 王岩[1] 

机构地区：[1]解放军总医院骨科,北京市100853

出　　处：《中国脊柱脊髓杂志》2016年第1期43-47,共5页Chinese Journal of Spine and Spinal Cord

摘　　要：目的：观察强直性脊柱炎（ankylosing spondylitis,AS）后凸畸形患者应用经椎弓根椎体截骨术（pedicle subtraction osteotomy,PSO）治疗后心功能的变化。方法 ：2011年10月~2013年10月共有36例行PSO的AS患者纳入本研究,男31例,女5例;年龄21~50岁（39±10岁）;病程5~27年（17±6年）,术前后凸Cobb角45.5°~108.8°（63.8°±22.4°）。术前和术后1年时评测患者静息心率、活动能力评分（active capacity score,ACS）,并行超声心动图检查,测量指标包括左心室射血分数（left ventricular ejection fraction,LVEF）、左心室缩短分数（left ventricular fraction shortening,LVFS）、左心室舒张早期血流峰值速度（E峰）、舒张中晚期血流峰值速度（A峰）、E/A比值、E峰减速时间（deceleration time,DT）、等容舒张时间（isovolumetric relaxation time,IVRT）,根据美国和欧洲超声学会指南评估患者左心室舒张功能。结果：随访至术后1年,共有32例完成了随访,失访率为11.1%。术后后凸Cobb角5.1°~34.5°（18.1°±10.9°）,矫正率43.8%~94.4%[（74.8±15）%]。术前静息心率为85.9±12.5次/min,术后1年随访时降低至71.8±9.7次/min（P=0.0000）;术前ACS为47.4±18.2分,术后1年随访时增加至78.3±12.6分（P=0.0000）。术前14例患者左心室舒张功能正常,术后1年随访时25例患者左心室舒张功能正常,其中2例术前左心室舒张功能正常的患者术后1年随访时为左心室舒张功能轻度障碍,临床改善率为72.2%（13/18）。E/A比值术前为1.02±0.36,术后1年随访时增加至1.24±0.27（P=0.0075）,术后1年随访时DT由术前234.84±32.46ms缩短至211.56±26.74ms（P=0.0027）,术前IVRT为102.50±19.86ms,术后1年随访时减少至87.92±13.12ms（P=0.0010）。术前和术后1年随访时LVEF和LVFS均正常,且无统计学差异（P〉0.05）。结论：AS后凸畸形患者PSO术后1年随访时心功能较术前有改善。Objectives： To observe the postoperative changes in cardiac function of patients with ankylosing spondylitis（AS） kyphosis after the pedicle subtraction osteotomy（PSO）. Methods： The original cohort consisted of 36 patients（31 males and 5 females） treated in our hospital from October 2011 to October 2013. The age was 21 to 50 years（39±10 years） and the duration of AS was 5 to 27 years（17±6 years）. Eehocardiographie measurements, resting heart rate（RHR）, active capacity seore（ACS）, and full-length spine X-ray films in natu- ral standing position were obtained before surgery and at 1-year follow-up. Echocardiographic parameters were measured as follows： left ventricular ejection fractiou（LVEF） and left ventficular fraction shortening（LVFS）, mi- tral early diastolic velocity（E）, late diastolic velocity（A）, E/A ratio, E deceleration time（DT） and isovolumetric relaxation time（IVRT）. And the left ventricular（LV） diastolic function was assessed by the recommendations of American and European Society of Echocardiography. Results： 32 patients（28 males and 4 females） completed the follow-up and 4 （3 males and 1 female） patients lost. The preoperative RHR was 85.9±12.5 beats per minute, whereas it was reduced to 71.8±9.7 beats per minute at 1-year follow-up（P=0.0000）. The ACS was improved from 47.4±18.2 points preoperatively to 78.3±12.6 points at 1-year follow-up（P=0.0000）. 14 patients （2 patients were turned into mild LV diastolic dysfunction at 1-year follow-up） had normal LV diastolic func- tion before operation while there were 25 patients at 1-year follow-up. The clinical improvement rate was 72.2%（13/18）. The preoperative DT was 234.84±32.46ms, and it was reduced to 211.56±26.74ms at 1-year follow-up（P=0.0027）. The IVRT before PSO was 102.50±19.86ms, while it decreased to 87.92±13.12ms at 1- year follow-up （P=0.0010）. The E/A ratio increased from 1.02±0.36 preoperatively to 1.24±0.27 at 1-year follow-up （P=0.00

关 键 词：强直性脊柱炎后凸畸形 心功能 静息心率 经椎弓根椎体截骨术 

分 类 号：R682.3[医药卫生—骨科学] R687.3[医药卫生—外科学]