经后路骨折间隙截骨治疗强直性脊柱炎胸腰椎应力骨折  

Posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis through the gap of a pathological fracture

作　　者：薛镜[1] 刘立岷[1] 宋跃明[1] 李涛[1] XUE Jing;LIU Limin;SONG Yueming;LI Tao(Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China)

机构地区：[1]四川大学华西医院骨科,成都610041

出　　处：《中国修复重建外科杂志》2018年第5期531-535,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨经后路骨折间隙截骨治疗强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎应力骨折的有效性及安全性。方法2012年4月—2015年8月,采用经后路骨折间隙截骨并椎间植骨治疗AS胸腰椎应力骨折患者8例,其中男7例,女1例;年龄37～74岁,平均51岁。AS病史1～40年,平均21.7年。胸背部应力骨折病程2～60个月,平均18.5个月。病变节段:T_(8、9)1例,T_(10、11)2例,T_(11)2例,T_(12)、L_11例,L_(1、2)1例,L_(2、3)1例。术前神经功能根据Frankel分级为D级3例,E级5例。收集患者手术前后X线片、三维CT及MRI等影像学资料,测量全脊柱最大后凸角(global kyphosis,GK)、局部后凸角(local kyphosis,LK)、固定节段角度(angle of the fusion levels,AFL)、骨盆入射角(pelvic incidence,PI)、骨盆倾斜角(pelvic tilt,PT)及矢状面平衡(sagittal vertical axis,SVA);采用疼痛视觉模拟评分(VAS)评价胸背部疼痛改善情况。结果手术时间210～320 min,平均267 min;术中出血量400～2 000 m L,平均963 m L。3例患者出现脑脊液漏,于术后5～7 d拔除引流管并缝合引流管口后切口逐步愈合;其余患者切口均Ⅰ期愈合。1例出现下肢麻木症状,术后给予口服甲钴胺1个月后恢复。8例患者均获随访,随访时间20～43个月,平均28.4个月。均未发生内固定物松动、断裂等并发症。所有患者骨折均愈合,愈合时间3～12个月,平均6.8个月。术后3个月,3例脊髓损伤患者Frankel分级由术前D级恢复至E级。所有患者术后1周及末次随访时GK、LK、AFL、PI、PT、SVA及VAS评分均较术前显著改善,差异有统计学意义(P<0.05);除末次随访时VAS评分显著低于术后1周(P<0.05)外,其余指标术后1周及末次随访间比较差异均无统计学意义(P>0.05)。结论经后路骨折间隙截骨能有效改善后凸畸形,纠正矢状面平衡,缓解胸背部疼痛并促进骨性愈合,是治疗AS胸腰椎应力骨折安全有效的方法。Objective To evaluate the effectivity and safety of posterior osteotomy for thoracolumbar stress fracture in ankylosing spondylitis（AS） through the gap of a pathological fracture. Methods Between April 2012 and August 2015, 8 patients with AS combined with thoracolumbar stress fracture were treated with posterior osteotomy through the gap of a pathological fracture to correct the kyphosis. There were 7 males and 1 female, with an average age of51 years（range, 37-74 years）. The history of AS was 1-40 years（mean, 21.7 years） and disease duration of stress fracture was 2-60 months（mean, 18.5 months）. The segmental lesions included T（8, 9） in 1 case, T（10, 11） in 2 cases, T（11） in 2 cases, T（12）, L1 in 1 case, L（1, 2） in 1 case, and L（2, 3） in 1 case. The nerve function before operation according to Frankel grading was grade D in3 cases and grade E in 5 cases. The pre-and post-operative X-ray films, CT three-dimensional reconstruction, and MRI were collected to measure the global kyphosis（GK）, local kyphosis（LK）, angle of the fusion levels（AFL）, pelvic incidence（PI）, pelvic tilt（PT）, and sagittal vertical axis（SVA）. Visual analogue scale（VAS） score was used to assess the back pain intensity. Results The operation time was 210-320 minutes（mean, 267 minutes）, and the intraoperative blood loss was400-2 000 m L（mean, 963 m L）. Cerebrospinal fluid leakage was found in 3 patients, and the wound healed by removal ofdrainage tube and suturing drainage outlet after 5-7 days of operation. The wounds of the rest patients healed by first intention. Lower extremity numbness occurred in 1 case and recovered after 1 month of postoperative administration of oral mecobalamin. All the patients were followed up 20-43 months（mean, 28.4 months）. No internal fixator loosening,fracture, and other complications occurred. All the fractures healed with the healing time of 3-12 months（mean, 6.8 months）. At 3 months after operation, 3 cases with spinal cord inju

关 键 词：强直性脊柱炎 截骨 应力骨折 假关节 

分 类 号：R687.3[医药卫生—骨科学]