后路复位固定联合经椎弓根截骨矫形术治疗强直性脊柱炎后凸畸形合并上颈椎损伤的疗效  

Efficacy of posterior reduction and fixation combined with pedicle subtraction osteotomy in the treatment of ankylosing spondylitis kyphotic deformity complicated by upper cervical spine injury

作　　者：张健[1] 何方生[2] 盛军[1] 买尔丹·买买提 曹锐[1] 徐韬[1] 梁卫东[1] 吴兵[2] 盛伟斌[1] Zhang Jian;He Fangsheng;Sheng Jun;Mardan·Mamat;Cao Rui;Xu Tao;Liang Weidong;Wu Bing;Sheng Weibin(Department of Spine Surgery,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Spine Surgery,Shihezi People′s Hospital,Shihezi 832099,China)

机构地区：[1]新疆医科大学第一附属医院脊柱外科,乌鲁木齐830054 [2]石河子市人民医院脊柱外科,石河子832099

出　　处：《中华创伤杂志》2024年第6期522-530,共9页Chinese Journal of Trauma

基　　金：新疆维吾尔自治区自然科学基金重点项目(2022D01D58);新疆维吾尔自治区自然科学基金青年科学基金项目(2022D01C745);新疆维吾尔自治区“天池英才”领军人才项目(2023.55)。

摘　　要：目的探讨后路复位固定联合经椎弓根截骨矫形术(PSO)治疗强直性脊柱炎(AS)后凸畸形合并上颈椎损伤的疗效。方法采用回顾性病例系列研究分析2010年10月至2022年12月新疆医科大学第一附属医院收治的8例AS后凸畸形合并上颈椎损伤患者的临床资料,均为男性;年龄32~58岁[(46.9±8.7)岁]。急性损伤1例,陈旧性损伤7例。3例颈胸椎后凸畸形,5例胸腰椎后凸畸形。合并齿状突骨折5例,C_(2~3)骨折1例,寰枢椎脱位2例。美国脊髓损伤学会(ASIA)分级:C级2例,D级3例,E级3例。根据畸形位置不同,行后路上颈椎损伤复位固定联合颈胸椎或胸腰椎PSO。记录手术时间及术中出血量。比较术前,术后1周、3个月、6个月、12个月及末次随访时颈椎功能障碍指数(NDI)、视觉模拟评分(VAS)、C_(0)~C_(2)角、C_(1)~C_(2)角、颈椎前凸角(CL)、头部倾斜角(HT)、颌眉角(CBVA)、颈椎矢状偏移距离(CSVA)、躯干矢状偏移距离(SVA)。术后12个月观察骨折愈合、截骨区融合情况。末次随访时观察神经功能恢复情况。观察并发症发生情况。结果患者均获随访12~24个月[(17.0±5.4)个月]。手术时间5.5~7.2 h[(6.2±0.6)h],术中出血量480~800 ml[(629.4±124.0)ml]。术后1周,3、6、12个月及末次随访时,NDI分别为(14.6±2.6)分、(13.6±2.8)分、(12.8±2.4)分、(12.8±2.7)分、(12.8±2.6)分,均低于术前的(29.6±8.5)分(P<0.01),术后各时间点NDI差异均无统计学意义(P>0.05);VAS分别为2.0(1.0,3.0)分、1.5(1.0,2.0)分、0.5(0.0,1.8)分、0.5(0.0,1.7)分、0.5(0.0,1.8)分,均低于术前的3.5(3.0,4.8)分(P<0.01);术后3个月VAS低于术后1周(P<0.05),术后6个月VAS低于术后3个月(P<0.05),术后6、12个月及末次随访时VAS差异均无统计学意义(P>0.05)。术前、术后各时间点C_(0)~C_(2)角、C_(1)~C_(2)角差异均无统计学意义(P>0.05)。术后1周,3、6、12个月及末次随访时,CL分别为-8.5(-5.3,-11.9)°、-8.6(-5.5,-11.9)°、-8.4(5.2,-12.1)°、-Objective To investigate the efficacy of posterior reduction and fixation combined with pedicle subtraction osteotomy(PSO)in the treatment of ankylosing spondylitis(AS)kyphotic deformity complicated by upper cervical spine injury.Methods A retrospective case series study was conducted to analyze the clinical data of 8 patients with AS kyphotic deformity complicated by upper cervical spine injury,who were admitted to First Affiliated Hospital of Xinjiang Medical University from October 2010 to December 2022.All were males,aged 32-58 years[(46.9±8.7)years].Acute injury was found in 1 patient and chronic injuries in 7 patients,including 3 with cervicothoracic kyphotic deformity and 5 with thoracolumbar kyphotic deformity.Five patients were complicated by odontoid fractures,1 by C_(2)-C_(3)fracture and 2 by atlantoaxial dislocation.According to American Spinal Injury Association(ASIA)scale,2 patients were with grade C,3 with grade D,and 3 with grade E.The patients were treated with posterior upper cervical reduction and fixation combined with cervicothoracic PSO or thoracolumbar PSO respectively according to the location of the deformity.The operation time and intraoperative blood loss were recorded.Neck disability index(NDI),visual analogue scale(VAS),C_(0)-C_(2)angle,C_(1)-C_(2)angle,cervical lordosis angle(CL),head tilt angle(HT),chin-brow vertical angle(CBVA),cervical sagittal vertical axis(CSVA),and sagittal vertical axis(SVA)were compared before surgery,at 1 week and 3,6,12 months after surgery,and at the last follow-up.The healing of fractures and fusion of osteotomy site were recorded at 12 months after surgery.Recovery of neurological function was observed at the last follow-up.Incidence of complications was observed.Results Patients were all followed up for 12-24 months[(17.0±5.4)months].The operation time was 5.5-7.2 hours[(6.2±0.6)hours]and the intraoperative blood loss was 480-800 ml[(629.4±124.0)ml].The NDI scores at 1 week and 3,6,12 months after surgery,and at the last follow-up were(14.6±2.6)poi

关 键 词：脊柱炎 强直性 脊柱骨折 颈椎 外科手术 

分 类 号：R687.3[医药卫生—骨科学]