矢状面横移在以开张式楔形截骨矫正手术治疗僵直性脊椎炎后凸畸型 .doc

矢状面横移在以开张式楔形截骨矫正手术治疗强直性脊椎炎后凸畸型之意义 张国华,陈盈佑,陈鸿昌,林建中 台湾，国军台中总医院骨科 [摘要] 目的 探讨脊柱矢状面横移在开张式楔形截骨术矫治强直性脊柱炎后凸畸形的意义。 方法 127例（年龄17~49岁）接受开张式楔形截骨手术之病患，以放射学及临床评估其结果，于截骨处头侧与尾侧脊柱之间于矢状面移位大于2毫米定义为矢状面横移，随访时间超过五年。 结果 34例（27%）发生矢状面横移，其中31例（94%）的后凸顶椎位于T11至L4之间，矢状面横移与术前腰椎后凸角度（lumbar kyphosis）及腰椎前凸矫正度（correction of lumbar lordosis）有正相关。34例矢状面横移中，有5例（15%）发生神经缺损并发症，相对于94例无矢状面横移者，仅有2例（2%）有神经损伤并发症。结论 矢状面横移为矫正矢状面失衡之基本机转，施作开张式楔形截骨位置靠近后凸畸型顶椎之病例较易发生，需要较大矫正才得以创造腰椎前凸角度及理想的矢状面失衡矫正的病例较需要矢状面横移加入其矫正机转。 [关键词] 开张式楔形截骨术，矢状面横移 Sagittal Translation in Opening Wedge Osteotomy for the Correction of Thoracolumbar Kyphotic Deformity in Ankylosing Spondylitis Kao-Wha Chang, MD, Hung-Chang Chen, MD, Ying-Yu Chen, MD, et al, Department of Orthopaedic Surgery, Armed Forces Taichung General Hospital, Taiwan, Republic of China. [Abstract] Objective This study is to document the frequency and nature of sagittal translation (ST) of the vertebral column during opening wedge osteotomy (OWO) for ankylosing spondylitis (AS) kyphosis and to consider its implications, predisposing factors, and complications. Methods We evaluated radiographic and clinical results in 127 patients (aged 17-49 y) for ST, or displacement of more than 2 mm between the cranial and caudal vertebral columns at the OWO level, over 5 y. Results Thirty-four (27%) patients had ST. In 31 (94%), the kyphotic apex was at T11 to L4. ST was positively correlated with the correction of lumbar lordosis and preoperative lumbar kyphosis. Five (15%) of 34 patients with ST had neurologic complications compared with two (2%) of 93 who did not. Conclusions ST is a basic mechanism for correcting sagittal imbalance and is likely to occur when the level of OWO is near the apex of deformity. Patients needing more correction of lumbar lordosis than others for best correction of sagittal imbalance need ST more to join the mechanism of correction. Key Words: ankylosing spondylitis, opening wedge osteotomy, pediculectomy, sagittal rotation 强直性脊椎炎会导致腰椎正常的前凸