摘要
目的观察并对比单节段脊柱去松质骨截骨(VCD)与双节段经椎弓根截骨(PSO)矫正强直性脊柱炎后凸畸形的临床效果。方法采用回顾性研究方法,选择2015年1月至2018年6月苏州市第九人民医院骨科收治的47例强直性脊柱炎后凸畸形矫形术后患者作为研究对象,所有患均行40°~65°截骨,根据手术方式的不同,将患者分为两组:VCD组(n=22)患者行单节段VCD治疗,PSO组(n=25)患者行双节段PSO治疗。观察两组患者的手术时间、术中出血量等手术指标,记录并对比两组患者治疗前后的胸腰椎最大后凸角(GK)、胸椎后凸角(TK)、腰椎前凸角(LL)、骨盆入射角(PI)、骨盆倾斜角(PT)、骶骨倾斜角(SS)等影像学指标,统计两组患者治疗前、治疗后6个月的Oswestry功能障碍指数(ODI)。结果VCD组患者的手术时间、术中出血量少于PSO组[(4.32±0.83)h vs.(6.59±1.24)h、(1235±603)ml vs.(1969±1214)ml],差异具有统计学意义(P<0.05)。PSO组中,治疗后的GK、TK、LL、PI、PT、SS均较治疗前有显著改善[(64.3±15.7)°vs.(31.4±14.2)°、(58.7±13.8)°vs.(49.7±14.8)°、(4.7±18.7)°vs.(52.9±14.6)°、(50.2±15.3)°vs.(40.8±15.3)°、(42.6±15.3)°vs.(20.1±14.3)°、(12.7±9.9)°vs.(30.6±8.4)°],差异具有统计学意义(P<0.05);VCD组中,治疗后的GK、LL、PI、PT、SS均较治疗前有显著改善[(65.3±14.2)°vs.(32.6±12.8)°、(5.9±19.5)°vs.(53.5±11.6)°、(49.6±14.3)°vs.(41.6±16.3)°、(40.8±14.6)°vs.(20.9±15.6)°、(12.4±9.6)°vs.(29.6±8.7)°],差异具有统计学意义(P<0.05),但TK与术前比较差异无统计学意义[(56.7±12.4)°vs.(52.2±15.6)°,P>0.05]。治疗后6个月,两组患者的ODI均较治疗前显著改善,差异具有统计学意义(P<0.05);治疗后6个月,两组患者的ODI组间比较差异无统计学意义(P>0.05)。结论单节段VCD与双节段PSO矫正强直性脊柱炎后凸畸形的临床效果接近,两种术式重建矢状面平衡与改善生活质量均令人满意,但前者的手术�
Objective To observe and compare the clinical effect of single segmental spondylitis canceling osteotomy(VCD)and double segmental transpedicular osteotomy(PSO)in correction of patients with kyphosis of ankylosing spondylitis.Methods A retrospective study was conducted in selection of 47 patients with ankylosing spondylitis kyphosis after orthopedics during January 2015 to June 2018 in Suzhou City.All these patients were treated with 40°~65°osteotomy,according to different surgical methods,patients were divided into two groups:patients in VCD group(n=22)were treated with single-segment VCD treatment,and patientsin PSO group(n=25)were treated with double-segment PSO.Surgical parameters such as operating time and amount of intraoperative blood loss were observed in these two groups.The maximum kyphosis angle(GK),thoracic kyphosis(TK)and lumbar lordosis(LL)of thoracolumbar spines before and after treatment were recorded and compared between these two groups.Oswestry dysfunction index(ODI)was measured before and after treatment in these two groups of patients,including pelvic angle of incidence(PI),pelvic tilt angle(PT),and sacral tilt angle(SS).Results The operating time and intraoperative blood loss in patients of VCD group were less than those of PSO group[(4.32±0.83)h vs.(6.59±1.24)h,(1235±603)ml vs.(1969±1214)ml],and the difference was statistically significant(P<0.05).In PSO group,GK,TK,LL,PI,PT,and SS were significantly improved after treatment[(64.3±15.7)°vs.(31.4±14.2)°,(58.7±13.8)°vs.(49.7±14.8)°,(4.7±18.7)°vs.(52.9±14.6)°,(50.2±15.3)°vs.(40.8±15.3)°,(42.6±15.3)°vs.(20.1±14.3)°,(12.7±9.9)°vs.(30.6±8.4)°],the difference was statistically significant(P<0.05).In the VCD group,GK,LL,PI,PT and SS after treatment were significantly improved compared with those before treatment[(65.3±14.2)°vs.(32.6±12.8)°,(5.9±19.5)°vs.(53.5±11.6)°,(49.6±14.3)°vs.(41.6±16.3)°,(40.8±14.6)°vs.(20.9±15.6)°,(12.4±9.6)°vs.(29.6±8.7)°],and the difference was statistically significant(P<0.
作者
范军界
李勇
金正帅
陈胜
吴卫东
孙立
FAN Jun-jie;LI Yong;JIN Zheng-shuai(Department of Orthopedics,Suzhou Ninth People's Hospital,Suzhou Jiangsu 215000,China;Department of Orthopedics,Jiangsu Shengze Hospital,Suzhou Jiansu 215228,China)
出处
《临床和实验医学杂志》
2019年第23期2557-2560,共4页
Journal of Clinical and Experimental Medicine
基金
江苏省科技支撑计划项目(编号:S201611)
关键词
强直性脊柱炎
脊柱后凸畸形
单节段脊柱去松质骨截骨
双节段经椎弓根截骨
矢状面平衡
生活质量
临床效果
Ankylosing spondylitis
Kyphosis of the spine
Single segmental cancellous spine osteotomy
Double-segment transpedicular osteotomy
Sagittal plane balance
Quality of life
Clinical effect
