张国华,黄信雄,陈鸿昌.闭合式与开张式截骨术治疗骨-台湾脊椎中心.doc

闭合式与开张式截骨术治疗强直性脊柱炎 并胸腰椎后凸畸形的比较 张国华, 黄信雄, 陈鸿昌 台湾，国军台中总医院骨科 [摘要] 目的：　　比较腰椎后路开张式截骨术（opening wedge osteotomy）和闭合式截骨术（closing wedge osteotomy）治疗强直性脊椎炎造成的胸腰椎后凸畸形的临床效果。方法：　　66例病人接受开张式截骨术，51例病人接受闭合式截骨术（102位男性，15位女性；平均年龄34.8岁（17~55岁）），依放射学结果、并发症、病人满意度来分析，平均随访3.6年（2.1~5.3年）。结果： 开张式截骨术及闭合式截骨术平均手术时间分别为183分钟及218分钟，平均失血量分别为1101毫升及1915毫升。比较最后放射线学的结果，开张式截骨术增加腰椎前凸（lumbar lordosis）37度，闭合式截骨术增加36度，开张式截骨术及闭合式截骨术在矢状面失衡（sagittal imbalance）方面改善程度分别为80mm及77mm。并发症包括，在开张式截骨术这组中，有3位病人有延迟性骨愈合及一位在截骨处发生金属杆断裂。全部病人中，6位发生暂时性神经缺损。无死亡案例或严重并发症，5位病人在手术部位和未手术部位交界处发生后凸畸型（Junctional kyphosis）（2位是接受开放式截骨术，3位接受闭合式截骨术），都需要再度接受手术治疗。两组病人临床上都得到高满意度。结论： 开放式及闭合式截骨术都是安全的，可获得好的临床结果。闭合式截骨术较开放式截骨术手术时间较长及失血量较多，但较少病人有麻痹性肠胀气或因延迟性愈合所造成的金属杆断裂。 [关键词] 强直性脊椎炎，闭合式截骨术，开张式截骨术 Closing Wedge Osteotomy Versus Opening Wedge Osteotomy in Ankylosing Spondylitis with Thoracolumbar Kyphotic Deformity Kao-Wha Chang MD, Hsin-Hsiung Huang MD, Hung-Chang Chen MD, et al, Department of Orthopaedic Surgery, Armed Forces Taichung General Hospital, Taiwan, Republic of China. [Abstract] Objective To compare lumbar posterior opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with thoracolumbar kyphotic deformity due to ankylosing spondylitis (AS). Methods Sixty-six patients underwent OWO, and 51 underwent CWO (102 male, 15 female; mean age, 34.8 years; age range, 17-55 years). Radiographic results, complications, and patient satisfaction were analyzed over a mean follow-up of 3.6 years (range, 2.1-5.3 years). Results For OWO and CWO, mean operative times were 183 and 218 minutes, and mean blood losses were 1101 and 1915 mL, respectively. Lumbar lordosis increased by 37°with OWO versus 36° with CWO group, as shown on final radiographs. Sagittal imbalance improved 80 and 77 mm with OWO and CWO, respectively. Complications included delayed union in three patients and a broken rod at the osteotomy site in the OWO group. Six transient neurologic deficits occurred overall. No mortality or major complications occurr