摘要
目的分析并评价强直性脊柱炎(ankylosing spondylitis,AS)胸腰段后凸畸形合并Andersson骨折患者通过脊柱后路经骨折线截骨手术应用PEEK(polyetheretherketone)融合器的疗效。方法回顾性分析2013年1月-2015年1月在我科应用PEEK融合器行脊柱后路经骨折线截骨手术治疗的27例AS胸腰段后凸畸形合并Andersson骨折患者临床资料,随访时间24~28(26.25±1.45)个月。收集患者手术前后正侧位X线片及CT检查图像,测量患者截骨平面高度及脊柱整体后凸角以评价手术效果,观察植骨融合情况,采用SRS-22量表评价术前及术后生活质量改善情况。结果 27例患者均顺利完成手术。术后1周、3个月、6个月、1年、2年截骨平面高度(level height,LH)均较术前无显著变化(P均>0.05),术后较术前后柱未见过度短缩。术后1周、3个月、6个月、1年、2年脊柱矢状面Cobb角矢状位平衡测量数据较术前显著改善(P均<0.05),术后各时间点间比较无明显差异(P>0.05)。术后3个月截骨处植骨融合率为77.8%,术后6个月为96.3%,术后1年为100%。术后6个月SRS-22各项得分均较术前明显增高,症状得到改善。随访期间,截骨矫形植骨融合部位X线复查未发现融合器移位、塌陷等情况。结论行脊柱后路经骨折线截骨矫形手术的AS胸腰段后凸畸形合并Andersson骨折患者术中应用Peek融合器安全有效,能够有效维持截骨部位高度及弧度,避免后柱过度短缩造成的硬脊膜和脊髓皱缩,长期随访临床效果满意。
Objective To evaluate the clinical outcomes of PEEK（Polyetheretherketone） cage for surgical treatment of thoracolumbar kyphosis deformity in ankylosing spondylitis patients with andersson fracture. Methods Clinical data about 27 patients who were diagnosed with ankylosing spondylitis thoracolumbar kyphosis with andersson fracture and treated by posterior osteotomy using PEEK cage in our hospital from January 2013 to January 2015 were retrospectively analyzed. All the patients were followed up for 24-28（26.25±1.45） months. Preoperative and postoperative radiographic data were recorded. The level height in osteotomy region（LH） and sagittal Cobb angle in globe kyphosis（GK） of the whole spine were measured on X-ray image and body fusion was evaluated. Scoliosis Research Society-22（SRS-22） was obtained to evaluate postoperative quality of life improvement. Results All surgeries were performed successfully without severe complications. There was no significant difference between preoperative and postoperative LH（all P 〉0.05）. Compared with before operation, the sagittal Cobb angle in globe kyphosis of the whole spine（GK） improved significantly after operation（P 〈0.05）, while no significant difference was found among each time point after operation（all P 〉0.05）. The fusion rate was 77.8% at 3 months after operation, 96.3% at 6 months and 100% at 1 year. The SRS-22 score increased significantly at 6 months after operation（P〈 0.05）. No cage displacement or collapse was found during follow-up. Conclusion Posterior osteotomy through fracture line with PEEK cage is an effective method for treatment of thoracolumbar kyphotic deformity in ankylosing spondylitis patients with andersson fracture and it can avoid potential spinal cord kinking or curving. PEEK cage maintains segmental height and restoration of lordosis angle effectively during long-term follow-up with high fusion rate.
作者
张少甫
胡凡琦
杨晓清
王尧
张智发
张雪松
ZHANG Shaofu;HU Fanqi;YANG Xiaoqing;WANG Yao;ZHANG Zhifa;ZHANG Xuesong(Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China)
出处
《解放军医学院学报》
CAS
2018年第5期400-404,共5页
Academic Journal of Chinese PLA Medical School
关键词
聚醚醚酮
胸腰段后凸
强直性脊柱炎
脊柱内固定
脊柱骨折
polyetheretherketone
thoracolumbar kyphosis
ankylosing spondylitis
spinal instrumentation
spinal fractures
