单节段与双节段经椎弓根椎体截骨术重塑强直性脊柱炎重度胸腰椎后凸畸形患者腰椎前凸曲线的效果及术式选择  

The efficacy and the selection of single-level and two-level pedicle subtraction osteotomy in the remodeling of lumbar lordosis curvature for patients with severe thoracolumbar kyphosis caused by ankylosing spondylitis

作　　者：李耀 钱邦平[1] 邱勇[1] 王斌[1] 孙旭[1] 乔军[1] LI Yao;QIAN Bangping;QIU Yong(Division of Spine Surgery,Department of Orthopedic Surgery,Nanjing Drum Tower Hos­pital,The Affiliated Hospital of Nanjing University Medical School,Nanjing,210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院骨科,脊柱外科,南京市210008

出　　处：《中国脊柱脊髓杂志》2021年第11期983-991,共9页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:分析单节段和双节段经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO)在强直性脊柱炎(ankylosing spondylitis,AS)重度胸腰椎后凸畸形(后凸Cobb角≥80°)患者中重塑其腰椎前凸曲线的效果,探讨两种术式的适应证。方法:回顾性分析68例接受PSO手术治疗的AS重度胸腰椎后凸畸形患者,其中44例接受单节段PSO治疗,24例接受双节段PSO治疗,随访时间为36.50±15.07个月。所有患者均在术前及末次随访时填写Oswestery功能障碍指数(Oswestry disability index,ODI)量表和视觉模拟量表(visual analogue scale,VAS)。测量术前、术后及末次随访时的胸腰椎后凸Cobb角(global kyphosis,GK)、矢状面躯干偏移(sagittal vertical axis,SVA)、胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骨盆倾斜角(pelvic tilt,PT)和骶骨倾斜角(sacral slope,SS)。将68例分别接受单节段和双节段PSO患者对比分析后,根据患者术后腰椎前凸顶点的位置分为两组,腰椎前凸顶点在L3或L4组(30例),腰椎前凸顶点在L5或其他腰椎组(38例),比较两组腰椎曲线的大小及形态。将良好的腰椎前凸曲线重塑定义为术后腰椎前凸顶点位于L3或L4水平,进一步筛选出30例实现良好的腰椎前凸曲线重塑的患者,再将其分为单节段PSO组(20例)和双节段PSO(10例)组,使用受试者操作特征(receiver-operating characteristic,ROC)曲线确定这两组之间存在显著性差异的术前影像学参数的最佳临界值(cut-off值)。结果:在68例重度胸腰椎后凸畸形患者中,接受单节段PSO组与双节段PSO组患者术后腰椎前凸顶点的分布无显著性差异(P>0.05),但是双节段PSO组手术时间更长、术中失血更多、固定节段更长(P<0.05)。术后腰椎前凸顶点在L5或其他腰椎组患者术后的LL和SS均显著小于L3或L4组(P<0.001),而两组患者术后的GK、SVA、TK和PT均无显著性差异(P>0.05);不同的截骨水平及截骨术式对术后腰椎前凸顶�Objectives:To analyze the remodeling of lumbar lordosis curvature between ankylosing spondylitis(AS)patients with severe thoracolumbar kyphosis(global kyphosis≥80°)who underwent single-or two-level pedicle subtraction osteotomy(PSO),and to determine the indications of single-level PSO and two-level PSO.Methods:68 patients with AS-related severe thoracolumbar kyphosis were retrospectively studied,including 44 patients underwent single-level PSO and 24 patients two-level PSO.The average follow-up time was 36.50±15.07 months.All the patients filled out the Oswestry disability index(ODI)and the visual analogue scale(VAS)before PSO and at the final follow-up.Radiological parameters including global kyphosis(GK),sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL),pelvic tilt(PT)and sacral slope(SS)were measured preoperatively,postoperatively and at the final follow-up.After comparison and analysis,the patients were divided into two groups based on the segment of postoperative apex of lumbar lordosis(LL apex):30 cases in LL apex at L3 or L4 group and 38 cases in LL apex at L5 or other segments group.Satisfying remodeling of lumbar lordosis curvature was defined as the postoperative LL apex located at L3 or L4.30 patients achieving satisfying remodeling of lumbar lordosis curvature were further screened out and then divided into single-level PSO group(20 cases)and two-level PSO group(10 cases).Receiver-operating characteristic(ROC)curve was used to find the cut-off value of preoperative parameters that were significantly different between the two groups.Results:In all 68 patients with severe thoracolumbar kyphosis,there was no significant difference in the relocation of LL apex between those underwent single or two-level PSO.However,longer operative time,more intraoperative blood loss and more levels of instruments were observed in those who underwent two-level PSO(P<0.05).After the patients were grouped based on the postoperative LL apex,the postoperative LL and SS in the L5 or other lumbar spine g

关 键 词：强直性脊柱炎 重度胸腰椎后凸畸形 经椎弓根椎体截骨术 腰椎前凸曲线 

分 类 号：R593.23[医药卫生—内科学] R687.3[医药卫生—临床医学]