摘要
目的 探讨不同截骨方式治疗强直性脊柱炎(AS)胸腰段后凸畸形患者的临床疗效。方法 选择2015年2月至2020年3月新乡市中心医院收治的AS致胸腰段后凸畸形患者106例为研究对象。根据手术方式将患者分为对照组(n=50)和观察组(n=56),对照组患者给予双节段经椎弓根椎体截骨(PSO)治疗,观察组患者给予单节段脊柱去松质骨截骨(VCD)治疗。比较2组患者的手术时间、术中出血量及住院时间。采用Oswestry功能障碍指数(ODI)评估2组患者术前和术后1 a时的脊柱功能障碍严重程度,采用脊柱侧凸研究学会(SRS)-22评分(包括功能活动、自我形象、疼痛、心理健康及治疗满意度5个维度)评估2组患者术前和术后1 a时的生活质量。测量患者站立位X线平片上的胸椎后凸角(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)。结果 观察组患者的手术时间、术中出血量及住院时间均显著低于对照组(P<0.05)。术前2组患者的ODI评分比较差异无统计学意义(P>0.05)。2组患者术后1 a的ODI评分均显著低于术前(P<0.05)。术后1 a,2组患者的ODI评分比较差异无统计学意义(P>0.05)。术前2组患者的功能活动、疼痛、自我形象、心理健康及治疗满意度评分比较差异无统计学意义(P>0.05)。2组患者术后1 a的功能活动、疼痛、自我形象、心理健康及治疗满意度评分均显著高于术前(P<0.05)。术后1 a,2组患者的功能活动、疼痛、自我形象、心理健康及治疗满意度评分比较差异无统计学意义(P>0.05)。2组患者术前TK、LL、SS、PI、PT角度比较差异无统计学意义(P>0.05)。2组患者术后1 a的TK、PI、PT角度显著小于术前,LL、SS角度显著大于术前(P<0.05)。术后1 a,2组患者的TK、LL、SS、PI、PT角度比较差异无统计学意义(P>0.05)。结论 单节段VCD治疗AS胸腰段后凸畸形患者具有便捷、高效的临床优势,能够有效减少手术时间、术中出血量及住院时间。
Objective To explore the clinical effectiveness of different osteotomy methods in the treatment of thoracolumbar kyphosis in ankylosing spondylitis(AS)patients.Methods A total of 106 patients with thoracolumbar kyphosis caused by AS admitted to Xinxiang Central Hospital from February 2015 to March 2020 were selected as the study subjects.The patients were divided into the control group(n=50)and the observation group(n=56)according to the surgical method.The patients in the control group were treated with dual segment pedicle subtraction osteotomy(PSO),the patients in the observation group were treated with single segment vertebral column decancellation(VCD).The operation time,intraoperative bleeding volume and hospital stay of patients were compared between the two groups.The severity of spinal dysfunction of patients in two groups was evaluated by Oswestry disability index(ODI)before and 1 year after operation,and the quality of life of patients in the two groups was evaluated by scoliosis research society(SRS)-22 score(including five dimensions:functional activities,self-image,pain,mental health and treatment satisfaction)before and 1 year after operation.The angles of thoracic kyphosis(TK),lumbar lordosis(LL),pelvic incidence(PI),pelvic tilt(PT)and sacral slope(SS)on the patient′s standing X-ray plain film were measured.Results The operation time,intraoperative bleeding volume and hospital stay of patients in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in ODI score of patients between the two groups before operation(P>0.05).The ODI score of patients at 1 year after operation was significantly lower than that before operation in the two groups(P<0.05).There was no significant difference in ODI score of patients between the two groups at 1 year after operation(P>0.05).There was no significant difference in functional activity,pain,self-image,mental health and treatment satisfaction scores of patients between the two groups before operation(P>0.05).The functional activity,pain,self-image,mental health and treatment satisfaction scores of patients at 1 year after operation were significantly lower than those before operation in the two groups(P<0.05).There was no significant difference in functional activity,pain,self-image,mental health and treatment satisfaction scores of patients between the two groups at 1 year after operation(P>0.05).There was no significant difference in TK,LL,SS,PI and PT angles of patients between the two groups before operation(P>0.05).The TK,PI and PT angles of patients at 1 year after operation were significantly lower than those before operation,while the LL and SS angles were significantly higher than those before operation in the two groups(P<0.05).There was no significant difference in TK,LL,SS,PI and PT angles of patients between the two groups at 1 year after operation(P>0.05).Conclusion The single segment VCD in the treatment of thoracolumbar kyphosis of AS patients has clinical advantages of convenient and efficiency.It can effectively reduce operation time,intraoperative bleeding volume and hospital stay.
作者
周大凯
朱振军
李慧宁
ZHOU Dakai;ZHU Zhenjun;LI Huining(Department of Spinal Surgery,Xinxiang Central Hospital,Xinxiang 453000,Henan Province,China)
出处
《新乡医学院学报》
CAS
2023年第10期975-978,共4页
Journal of Xinxiang Medical University
关键词
强直性脊柱炎
后凸畸形
截骨方式
单节段脊柱去松质骨截骨
双节段经椎弓根椎体截骨
矢状位平衡
ankylosing spondylitis
kyphosis deformity
osteotomy method
single segment vertebral column decance-llation
double segment pedicle subtraction osteotomy
sagittal balance
