截骨矫形术治疗强直性脊柱炎颈胸段畸形的疗效分析  

Corrective osteotomy for cervicothoracic deformity secondary to ankylosing spondylitis

作　　者：钱邦平[1] 黄季晨 邱勇[1] 王斌[1] 蒋军[1] 乔木 

机构地区：[1]南京大学医学院附属鼓楼医院脊柱外科,210008

出　　处：《中华骨科杂志》2018年第4期204-211,共8页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81372009）;江苏省临床医学中心（YXZXA2016009）

摘　　要：目的 探讨C7T1伸展性截骨及C7经椎弓根椎体截骨（C7 PSO）治疗强直性脊柱炎（ankylosing spondylitis,AS）颈胸段畸形的临床疗效及并发症情况。方法 2006年4月至2017年8月接受颈胸段截骨矫形术治疗的8例AS颈胸段畸形患者,均为男性;年龄14~60岁,平均（31.3±14.9）岁。3例前纵韧带无骨化或骨化程度较轻的颈胸段单纯后凸畸形者行C7T1伸展性截骨矫形,5例前纵韧带骨化严重或合并颈胸段侧后凸双平面畸形者行C7 PSO截骨矫形。记录手术时间、术中出血量及并发症情况。测量术前、末次随访时颈胸段后凸Cobb角、颈胸段侧凸Cobb角、颏眉角（chin-brow vertical angle,CBVA）和颈胸段矢状面偏移（C2-T1 sagittal vertical axis, SVA）,评估临床疗效。结果 8例患者均获得随访,随访时间3~48个月,平均（11.3±7.9）个月。3例C7T1伸展性截骨患者手术时间平均为275 min（270~280 min）,术中出血量平均为1250 ml（1000~1500 ml）。术前颈胸段后凸Cobb角平均为17.0°±16.3°,末次随访改善至-13.3°±20.2°,平均矫正率178.2%;术前CBVA平均为20.0°±4.5°,末次随访改善至4.7°±5.9°,平均矫正率76.5%;术前SVA平均为（6.9±4.0） cm,末次随访改善至（3.5±1.8）cm,平均矫正率49.3%。5例C7 PSO患者手术时间平均为536 min（375~730 min）,术中出血量平均为2450 ml（700~4200 ml）。4例合并侧后凸畸形,术前后凸Cobb角平均为22.8°±10.5°,末次随访改善至-13.5°±10.0°,平均矫正率159.2%;术前侧凸Cobb角平均为24.8°±12.7°,末次随访改善至5.0°±3.5°,平均矫正率79.8%;术前CBVA平均为60.5°±10.2°,末次随访改善至14.3°±8.6°,平均矫正率76.4%;术前SVA平均为（10.4±4.3） cm,末次随访改善至（6.4±2.5） cm,平均矫正率38.5%。1例严重颈胸段侧凸畸形,术前侧凸Cobb角33°,末次随访改善至10°,改善率69.7%。8例患者术中、术后随访期间均未出现神经并发症,无感染发生,无螺钉松动、断�Objective To report the application of C7T1 extensive osteotomy and C7 pedicle subtraction osteotomy （PSO） in the correction of cervicothoracic deformity secondary to ankylosing spondylitis （AS） and to investigate the efficacy and safety of the techniques. Methods Between April 2006 and August 2017, eight male patients with cervicothoracic deformity undergoing C7T1 extensive osteotomy （3 cases） or C7 PSO （5 cases） were retrospectively reviewed. The mean age was 31.3±14.9 years （range, 14-60 years）. C2-T1 kyphosis, C2-T1 scoliosis and C2-T1 sagittal vertical axis （SVA） were measured on the lateral cervical radiographs and chin-brow vertical angle （CBVA） was measured on clinical photographs preoperatively and at the final follow-up. The operative time, blood loss and complications were recorded. Results The average follow-up duration was （11.3±7.9） months （range, 3-48 months）. In C7T1 extensive osteotomy group, the mean operative time was 305 min （300-310 min） and the average blood loss was 1 250 ml （1 000-1 500 ml）. Preoperative and postoperative C2-T1 kyphosis were 17.0°±16.3° and -13.3°±20.2°, respectively. The preoperative CBVA was 20.0°±4.5°, which improved to 4.7°±5.9°at the final follow-up with a mean correction rate of 76.5%. C2-T1 SVA was improved from （6.9±4.0） cm preoperatively to （3.5±1.8） cm at the final follow-up with an average correction rate of 49.3%. In C7 PSO group, the mean operative time was 536 min （375-730 min） and the average blood loss was 2 450 ml （700-4 200 ml）. There were four patients with concomitant scoliosis and kyphosis. Preoperative and postoperative C2-T1 kyphosis were 22.8°±10.5° and -13.5°±10.0°, respectively. The preoperative C2-T1 scoliosis was 24.8°±12.7°, which improved to 5.0°±3.5° at the final follow-up with a mean correction rate of 79.8%. CBVA was improved from 60.5°±10.2° preoperatively to 14.3°±8.6° at the final follow-up with an average correction rate of 76.4%. C2-T1 SVA was

关 键 词：脊柱炎 强直性 颈椎 胸椎 脊柱后凸 截骨术 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]