長节段椎弓根钉系统内固定与个性化截骨方法治疗强直性脊柱炎后凸畸形.docVIP

长节段椎弓根钉系统内固定与个性化截骨方法治疗强直性脊柱炎后凸畸形 王晓平，陆 明，马华松，周建伟，袁 伟，陈 阳，牛 晶，任冬云，秦柳花，郑 蕊，张 敬(解放军第三○六医院骨科，北京市 100101) 文章亮点： 1 文章的特点为结果显示了选择性长节段植入物内固定加截骨矫形技术能够获得稳定的内固定疗效，防止出现矢状位失平衡，以及强直性脊柱炎因骨质疏松导致的拔钉、断钉、断棒现象的发生。 2 考虑到强直性脊柱炎患者个体差异，除植入物内固定外，方法中增加了对L2及L3椎板截骨来达到脊柱矢状面上的平衡，并非单纯在上位的畸形顶椎部进行截骨，而是通过人为地增大腰椎前凸，以代偿脊柱上部的后凸畸形，改善患者外观。 关键词： 骨关节植入物；脊柱植入物；强直性脊柱炎；经椎弓根截骨；椎体截骨；内固定；矢状位平衡；植骨融合 主题词： 脊柱炎，强直性；截骨术；内固定器；脊柱融合术 摘要 背景：生物力学的观点认为：强直性脊柱炎的矫形在后凸的顶点处截骨最佳，但术中脊髓损伤的风险大。 目的：分析联合应用椎板间截骨+椎体截骨+长节段椎弓根钉系统内固定治疗强直性脊柱炎后凸畸形的临床效果。 方法：强直性脊柱炎患者共36例，均采用PSO(Pedicle Subtraction Osteotomy)截骨+SPO(Smith-Peterson Osteotomy)联合截骨治疗。随访时间3个月至2年。 结果与结论：36例患者未发现植入物修复后矢状位失平衡者，矢状位失衡的改善率为64%。患者植入物修复后胸腰椎后凸角的到恢复，改善率为60%；颌眉角的改善率为98%，疼痛症状缓解程度为64%，ODI指数95%；均未发生拔钉、断钉、断棒现象。说明选择性截骨矫形技术+长节段内固定手术能够获得稳定的内固定疗效，防止出现矢状位失平衡，以及强直性脊柱炎因骨质疏松导致的拔钉、断钉、断棒现象的发生。 Long-segment pedicle screw fixation and individual osteotomy in the treatment of ankylosing spondylitis with kyphosis Wang Xiao-ping, Lu Ming, Ma Hua-song, Zhou Jian-wei, Yuan Wei, Chen Yang, Niu Jing, Ren Dong-yun, Qin Liu-hua, Zheng Rui, Zhang Jing (Department of Orthopedics, the 306th Hospital of PLA, Beijing 100101, China) Abstract BACKGROUND: Orthopedic osteotomy at the apex of kyphosis is best for treatment of ankylosing spondylitis from a biomechanical aspect, but there is a high risk for intraoperative spinal cord injury. OBJECTIVE: To explore the clinical efficacy of vertebral plate osteotomy + vertebra osteotomy +long-segment pedicle screw fixation in the treatment of ankylosing spondylitis with kyphotic deformity. METHODS: Thirty-six patients with ankylosing spondylitis were subjected to pedicle subtraction osteotomy and Smith-Peterson osteotomy, and then followed up for 3 months to 2 years. RESULTS AND CONCLUSION: After implantation, sagittal imbalance did not occur in 36 patients, and the improvement rate of sagittal imbalance was 64%. The improvement rates of thoracolumbar kyphosis and chin-brow vertical angle were 60% and 98%, respectively. The pain relief rate was