VCR、VCD治疗强直性脊柱炎并发重度车轮状后凸畸形的临床研究

目的：比较全脊椎切除术（VCR）、脊柱去松质骨截骨（VCD）治疗强直性脊柱炎并发重度车轮状后凸畸形的临床疗效。方法：选取我院2012年12月～2014年12月间收治的35例强直性脊柱炎并发重度车轮状后凸畸形的患者，将患者随机分为VCR手术组（n=17）和VCD手术组（n=18），分别行VCR、VCD手术治疗，以术后1周的全脊柱最大后凸Cobb角、颌眉角、C7铅垂线评价矫正效果，评估患者满意度、记录不良反应发生率。结果：VCR组治疗后全脊柱最大后凸Cobb角（33.5±6.7）°、颌眉角（10.1±6.5）°、C7铅垂线（11.7±5.8cm）与治疗前相比，VCD组治疗后3项指标分别为（29.4±6.8）°、（9.8±5.7）°和（12.2±5.6）cm与治疗前相比，差异均具有统计学意义。患者末次随访时VCD患者总满意度明显高于VCR组，差异具有统计学意义。两组不良反应均轻微，不良反应发生率比较差异无统计学意义。结论：VCR和VCD治疗强直性脊柱炎后期并发重度车轮状后凸畸形均有很好的临床疗效，且安全性很高，但VCD患者的总满意度显著高于VCR组，提示VCD的长期效果可能优于VCR。

Clinical study of VCR and VCD in the treatment of ankylosing spondylitis complicated with severe wheel like deformity

Objective To compare the clinical effect of total spine resection (VCR) and spinal cord to cancellous bone (VCD) in the treatment of ankylosing spondylitis complicated with severe wheel like deformity. Methods in our hospital in December 2012 to December 2014 from 35 cases of ankylosis spondylitis complicated with severe wheel shaped convex deformity pa-tients, the patients were randomly divided into the VCR operation group (n=17) and VCD operation group (n=18), respectively, VCR, VCD surgical treatment and 1 week after the operation of the whole spine maximum Cobb angle, chin brow vertical angle, the C7 plumb line evaluation correction effect, evaluation of patient satisfaction, recording the incidence of adverse reactions. Results The VCR group after treatment, the total spine maximum Cobb angle (33.5+6.7 degrees), chin brow vertical angle (10.1 ±6.5) degrees, C7 plumb (11.7±5.8) cm compared with before treatment, VCD group after treatment 3 index (respectively 29.4 ±6.8 degrees, 9.8±5.7 degrees and 12.2±5.6CM) compared with that before treatment compared with statistical significance. At the last follow-up, the total satisfaction of VCD patients was significantly higher than that of the VCR group, the difference was statistically significant. Adverse reactions in the two groups were mild, and there was no significant difference in the incidence of adverse reactions. Conclusion VCR and VCD on ankylosing spondylitis late concurrent severe wheel shaped convex deform-ity were very good curative effect, and the safety is very high, but total satisfaction of patients with VCD was significantly higher than that of VCR, VCD prompt long-term effect is better than a VCR.