颌眉角的最优选择及其在强直性脊柱炎后凸畸形矫形设计中的应用

目的探索不同范围颌眉角对颈椎强直性脊柱炎（ankylosingspondylitis，AS）患者日常生活的影响，确定最优的颌眉角范围，进而为截骨矫形设计提供理论依据。方法选取我科收治的25例颈椎强直的 AS 胸腰段后凸畸形患者，所有患者矫形前后均完成视野相关生活质量功能及期望评分调查问卷表。不考虑手术与否，按照自然站立位颌眉角将所有外观照所对应病例（ n＝50）分为6组：A 组，CBVA＜0°；B组，0°≤CBVA＜10；C 组，10°≤CBVA＜20°；D组，20°≤CBVA＜30°；E 组，30°≤CBVA＜40°；F组， CBVA≥40°。将6组患者每项调查问卷项目进行比较分析，多组间比较时采用Kruskal-Wallis检验，组间两两比较采用Mann-Whitney检验。结果总体评价：C组（10～20）°获得最优的期望值评价，P＜0.05。B、C、D 组（0～30）°获得较其它组更好的功能评价，P＜0.05，但三组间差异无统计学意义。形象评价：A、B、C 组（＜20°）较其它组获得更好的形象满意度及期望值，P＜0.05，但三组间差异无统计学意义。户外活动：A、B、C、D组（＜30°）在多数项目上较其它组获得更好的功能评价及期望值评价。室内活动：C、D组（10～30）°在多数项目上较其它组获得较好的功能评价及期望评价。结论颌眉角在10°～20°时，患者视野相关活动功能及满意度最高，因此，10°～20°为颌眉角的最佳矫正角度。

Optimal chin-brow vertical angle and its application for deformity planning in ankylosing spondylitis kyphosis

Objective To investigate effects of chin-brow vertical angle （ CBVA ） in different ranges on daily life of ankylosing spondylitis （ AS ） patients with cervical ankylosis, so as to determine the optimal CBVA and further provide theoretical basis for osteotomy planning.Methods A total of 25 AS patients with thoracolumbar kyphosis and cervical ankylosis were studied, whose functions and expectations of quality of life （ QOL ） related to visual ifeld were assessed by a questionnaire before and after the surgery. The CBVA was obtained based on lateral photos of the patients in natural standing posture. All the cases （n=50 ） were divided into 6 groups according to the CBVA irrespective of surgery, including group A （ CBVA〈0° ）, group B （ 0°≤CBVA〈10° ）, group C （ 10°≤CBVA〈20° ）, group D （ 20°≤CBVA〈30° ）, group E （ 30°≤CBVA〈40° ） and group F （ CBVA≥40° ）. The Kruskal-Wallis test was used to assess differences among all the groups in terms of various items in the questionnaire, and the Mann-Whitney test was used to assess differences between 2 groups.Results In overall evaluation, the optimal expectation value was obtained in group C （ 10-20 ） ° （P〈0.05 ）, and better expectation value was obtained in group B, C and D （ 0-30 ） ° （P〈0.05 ）, with no statistically signiifcant differences among the 3 groups. In appearance evaluation, group A, B and C （ 〈20° ） were better than the other groups both in appearance satisfaction degree and expectation （P〈0.05 ）, with no statistically signiifcant differences among the 3 groups. In outdoor activities, better functions and expectations were achieved in group A, B, C and D （ 〈30° ） in most of the items. In indoor activities, group C and D （ 10-30 ） ° were much better in most of the items.Conclusions AS patients with cervical ankylosis have the best QOL related to visual ifeld and are most satisifed with the appearance when 10°≤CBVA〈20°.