摘要
目的:分析术前应用数字化智能软件Surgimap Spine辅助设计截骨矫形治疗强直性脊柱炎(ankylosing spondylitis,AS)胸腰椎后凸畸形的临床疗效。方法:回顾性分析2019年1月~2021年4月于河南省人民医院脊柱脊髓外科行截骨矫形治疗AS胸腰椎后凸畸形患者的临床资料,男15例,女1例;年龄19~46岁(32.7±8.1岁)。术前将脊柱全长侧位X线片导入Surgimap Spine软件,测量骨盆参数、颌眉角(chin-brow vertical angle,CBVA)和矢状面平衡距离(sagittal vertical axis,SVA)等矢状位参数;旋转骨盆倾斜角(pelvic tilt,PT)达到理想数值;连接C7椎体中心与S1后上角连线,沿拟定截骨椎前方皮质中心将C7中心旋转至骶骨正上方,旋转角度α即为预测SVA=0mm时截骨角度;应用截骨工具模拟SVA=50mm时截骨角度β;再应用截骨工具分别模拟CBVA=10°和20°时所需截骨角度γ、δ,颈椎受累者δ≤截骨角度λ≤γ且满足β≤截骨角度λ≤α;颈椎未受累者β≤截骨角度λ≤α。根据设定截骨角度范围,指导术中截骨。术前、术后2周及末次随访时拍摄脊柱全长X线正侧位片,测量并比较CBVA、脊柱整体后凸角(global kyphosis,GK)、胸椎后凸角(thoracic kyphosis,TK)、胸腰椎后凸角(thoracolumbar kyphosis,TLK)、腰椎前凸角(lumbar lordosis,LL)、PT、骨盆入射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆入射角(PI)与腰椎前凸角(LL)之差(PI-LL)、SVA等参数,采用SRS-22评分(Scoliosis Research Society-22 questionnaire)和Oswestry功能障碍指数(Oswestry disability index,ODI)评估临床疗效,同时记录手术相关并发症情况。结果:患者手术均顺利完成,5例患者合并颈椎强直,其中3例无法同时满足SVA和CBVA需求,根据术者经验进行权衡。手术时间350~490min(420±38.9min),术中出血量900~1900ml(1366.5±337.3ml)。术后随访6~24个月,平均12.6±5.6个月。手术前、术后2周及末次随访时的CBVA分别为33.1°±13.1°、8.2°±3.8°、10.5°±4.2°;GK分别为68.5°±28.4°、35.4°±12.0°、36.1°±10.6°;TK分别为51.3°±17.3°、35.9°±9.9°、35.7°±8.7°;TLK分别为31.5°±16.1°、15.2°±7.4°、14.5°±7.2°;LL分别为-2.3°±20.8°、-39.7°±12.9°、-37.8°±8.9°;PT分别为36.5°±11.5°、23.2°±9.1°、25.4°±7.9°;SS分别为13.2°±8.8°、25.2°±8.5°、26.2°±8.7°;PI-LL分别为37.3°±15.6°、8.3°±8.7°、10.5°±9.5°;SVA分别为175.3±47.4mm、38.2±10.2mm、44.2±11.3mm。术后2周及末次随访时与手术前比较均有显著性改善,差异有统计学意义(P<0.05)。术前、术后2周及末次随访时的PI值为48.2°±13.3°、48.0°±12.7°、48.1°±12.3°,无显著性改变(P>0.05)。末次随访时的ODI和SRS-22与术前比较均有显著性改善(P<0.05)。术后水平视线及生活能力均明显改善,末次随访时未见内固定松动、移位及断裂,植骨融合充分。结论:术前应用数字化智能软件Surgimap Spine辅助设计截骨治疗AS胸腰椎后凸畸形可行,临床疗效满意。
Objectives:To analyze the clinical effect of preoperative osteotomy and orthopedic design by using Surgimap Spine software in the treatment of thoracolumbar kyphosis in ankylosing spondylitis(AS).Methods:The patients who underwent osteotomy and orthopedic correction for AS thoracolumbar kyphosis at the Department of Spine and Spinal Cord Surgery,Henan Provincial People′s Hospital,from January 2019 to April 2021,were retrospectively analyzed,which included 15 males and 1 female,aged 19-46 years(32.7±8.1 years).Before operation,a full-length spine lateral radiograph was imported to the Surgimap software,and sagittal parameters such as pelvic parameters,chin-brow vertical angle(CBVA),and sagittal vertical axis(SVA)were measured;the pelvic tilt(PT)angle was revolved to ideal values;the line between the center of the C7 vertebra and the posterosuperior corner of S1 was connected,the center of C7 was rotated to just above the sacrum along the center of the cortex in front of the proposed osteotomy vertebra,and the angle of rotationαwas calculated as the angle of osteotomy in prediction of SVA=0mm;The angle(β)at SVA=50mm was simulated using osteotomy tool.The osteotomy tool was then applied to simulate the angles(γ,δ)needed at CBVA=10°and 20°,respectively.Patients with cervical ankylosisδ≤osteotomy angleλ≤γandβ≤osteotomy angleλ≤α;Patients without ankylosis of the cervical spine,β≤osteotomy angleλ≤α.Intraoperative osteotomies were guided according to the set range of osteotomy angles.Anteroposterior and lateral radiographs of the entire spine were performed preoperatively,2 weeks postoperatively,and at final follow-up,and CBVA,global kyphosis(GK),thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),lumbar lordosis(LL),PT,pelvic incidence(PI),sacral slope(SS),the value of PI-LL,SVA and other parameters were measured and compared.Scoliosis Research Society-22(SRS-22)questionnaire score and Oswestry disability index(ODI)were used to evaluate the clinical efficacy,and the surgical related complications were recorded.Results:The procedures were uneventful in all patients,and 5 patients were combined with cervical ankylosis,3 of whom could not meet both SVA and CBVA needs,which were weighed according to the surgeon′s experience.The operative time was 350-490min(420±38.9min)and intraoperative blood loss was 900-1900ml(1366.5±337.3ml).Postoperative follow-up ranged from 6 to 24 months with a mean of 12.6±5.6 months.Before surgery,2 weeks after surgery,and at final follow-up,CBVA was 33.1°±13.1°,8.2°±3.8°,and 10.5°±4.2°;GK was 68.5°±28.4°,35.4°±12.0°,and 36.1°±10.6°;TK was 51.3°±17.3°,35.9°±9.9°,35.7°±8.7°;TLK was 31.5°±16.1°,15.2°±7.4°,14.5°±7.2°;LL was-2.3°±20.8°,-39.7°±12.9°,and-37.8°±8.9°,respectively;PT was 36.5°±11.5°,23.2°±9.1°,and 25.4°±7.9°;SS was 13.2°±8.8°,25.2°±8.5°,and 26.2°±8.7°;PI-LL was 37.3°±15.6°,8.3°±8.7°,and 10.5°±9.5°;SVA was 175.3±47.4mm,38.2±10.2mm,and 44.2±11.3mm,respectively.Significant improvements of the above parameters were observed at 2 weeks postoperatively and at final follow-up compared with those before surgery(P<0.05).The PI was 48.2°±13.3°,48.0°±12.7°,and 48.1°±12.3°preoperatively,2 weeks postoperatively,and at final follow-up,respectively,with no significant changes(P<0.05).Both ODI and SRS-22 at final follow-up were significantly improved compared with their preoperative values(P<0.05).The horizontal gaze and living ability were improved significantly after the operation,and no internal fixation loosening,displacement or fracture were observed at final follow-up,and the bone graft fusion was sufficient.Conclusions:It is feasible to apply digital intelligent software-Surgimap Spine to assist designing osteotomy before operation for the treatment of thoracolumbar kyphosis in AS,and the clinical outcomes can be satisfactory.
作者
张博
杨光
吕东波
曹臣
张敬乙
高延征
ZHANG Bo;YANG Guang;LU Dongbo(Henan University People's Hospital,Department of Spine and Spinal Cord Surgery,Henan Provincial People's Hospital,Zhengzhou,450003,China)
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2022年第4期297-304,共8页
Chinese Journal of Spine and Spinal Cord
基金
河南省科技厅省部共建项目(SB201901085)。
