经关节突V形截骨矫治强直性.docVIP

经多节段关节突“V”形截骨矫治强直性 脊柱炎胸腰椎后凸畸形 张铭华 李波 钟斌 余雨 （重庆第二人民医院骨科二病区，重庆 402160） 摘要[目的] 评价经关节突“V”形截骨术治疗强直性脊柱炎胸腰椎后凸畸形的临床疗效。[方法] 共13例，男9例，女4例；年龄22～49岁，平均34岁。均行多节段经关节突“V”形截骨及椎弓根钉棒系统固定术。 [结果] 手术顺利，无严重并发症发生。手术时间2.5～4.0小时，平均3.2小时。术中出血600～1300ml，平均980ml。术前后凸Cobb角420～880，平均620，术后平均矫正度为480。随访1～5年，平均3年，矫正度丢失平均为7.40，均达骨性融合。 [结论] 对于前纵韧带骨化轻微的强制性脊柱炎后凸畸形，采用多节段经关节突“V”形截骨术，可获得较满意的矫形效果。 关键词：强直性脊柱炎；后凸畸形；截骨术 Vertebral body “V” shaped osteotomy for correction of kyphosis in ankylosing spondylitis∥ZHANG Ming-hua,LI Bo, ZHONG Bin,et al, Department of Orthopedics, The Second Peoples Hospital of Chongqing, Yongchuan Chongqing 402160,China Abstract [Objective] To assess the outcomes of vertebral body “V” shaped osteotomy for correction of kyphosis in ankylosing spondylitis. [Methods] Thirteen patients including 9 male and 4 female were converged in this study with mean age 34 years(ranging from 22 to 49 years).These patients were treated with multi-segmental vertebral body “V” shaped osteotomy and internal fixation by pedicle screw system. [Results] All the operations were well complete. The mean time of operations was 3.2h(range: 2.5h～4.0h) and the mean bleeding was 980ml(range: 600 ml～1300 ml).The average preoperative deformity was620(range: 420～880),the total postoperative correction was 480.After a mean follow-up 0f 3 years ranging from 1 year to 5 years,the average correction loss of 7.20 was seen in group. [Conclusion] Multi-segmental vertebral body “V” shaped osteotomy is a feasible and an effective procedure for correction of kyphosis in ankylosing spindylitis. This procedure is best indicated for patients with trivial ossification of the anterior longitudinal ligment. [Key words] ankylosing spindylitis； kyphosis； osteotomy 强直性脊柱炎（ankylosing spindylitis，AS）若得不到及时治疗，晚期可使脊柱旁的关节突关节和椎间组织等结构融合硬化，导致脊柱过度后凸畸形，破坏身体矢状面上的平衡，不仅影响日常活动，还对患者心理产生严重影响，交际障碍明显。作者回顾性分析本院2002年3月～2007年12月间行多节段经关节突“V”形截骨术治疗AS胸腰椎后凸畸形13例，近期疗效满意，现报告如下。 1　临床资料 1．1 一般资料 本组13例，男9例，女4例；年龄22～49岁，平均34岁