两种截骨矫形术式治疗强直性脊柱炎重度胸腰椎后凸畸形的临床效果与并发症分析

目的比较两种截骨矫形术式治疗强直性脊柱炎（ankylosingspondylitis，AS）重度胸腰椎后凸畸形的临床效果及围手术期并发症。方法将2009年5月至2013年12月，33例后凸＞70°的AS重度胸腰椎后凸畸形患者，根据截骨术式的不同分为两组。双节段（ pedicle subtraction osteotomy，PSO ）组（18例）：均为男性，年龄19～47（平均34.8±10.6）岁；脊柱后凸Cobb’s角（82.6±17.5）°（70～108）°；C7铅垂线与骶骨后上角之间的垂直距离（ sagittal vertical axis，SVA ）为（18.3±14.8） cm （11～35） cm；站立位颌眉垂线角为（67.2±21.9）°（43～130）°；单节段（ closing-opening wedge osteotomy，COWO ）组（15例）：男13例，女2例，年龄22～43（平均31.2±8.5）岁，脊柱后凸Cobb’s角（76.3±11.2）°（73～98）°；SVA为（16.7±7.3） cm （10～26） cm；颌眉垂线角为（63.5±15.6）°（ 47～86）°。比较两组的临床矫形效果及围手术期并发症。结果双节段PSO组脊柱后凸角、颌眉垂线角以及SVA矫正率分别为（74.2±8.3）%，（86.2±9.5）%和（83.6±10.2）%；COWO组脊柱后凸角、颌眉垂线角以及SVA矫正率分别为（70.2±6.5）%，（86.6±8.3）%和（88.0±8.7）%，以上矫正率两组之间差异无统计学意义（ P＞0.05）；但在手术时间和出血量上，两节段PSO组明显高于COWO组（ P＜0.05）。COWO组围手术期并发症发生率显著高于双节段PSO组（ P＜0.05），尤其以术中螺钉松动和截骨断端移位发生率高。结论对AS重度胸腰椎后凸畸形患者，单节段COWO可以取得与双节段PSO相似的临床效果，且单节段COWO手术时间短，出血量少，但围手术期并发症相对要高。

Clinical outcomes and complication analysis of two kinds of osteotomy for severe thoracolumbar kyphosis seondary to ankylosing spondylitis

Objective To compare the clinical outcomes and perioperative complications between 2 kinds of osteotomy in the treatment of severe thoracolumbar kyphosis （ TLK ） secondary to ankylosing spondylitis （ AS ）. Methods From May 2009 to December 2013, 33 AS patients with severe TLK of more than 70° were divided into 2 groups because of the different osteotomy methods. A total of 18 male patients underwent double-segment pedicle subtraction osteotomy （ PSO ） in group 1, whose average age was （ 34.8±10.6 ） years old （ range： 19-47 years ）. The global kyphosis （ GK ） angle was （ 82.6±17.5 ） ° （ range： 70°-108° ）, and the chin-brow vertical angle was （ 67.2±21.9 ） ° （ range： 43°-130° ）. The sagittal vertical axis （ SVA ） from the C7 plumb line to the posterior superior corner of the sacrum was （ 18.3±14.8 ） cm （ range： 11-35 cm ）. The patients underwent mono-segment closing-opening wedge osteotomy （ COWO ） in group 2. There were 13 males and 2 females, with an average age of （ 31.2±8.5 ） years old （ range： 22-43 years ）. The GK angle, chin-brow vertical angle and SVA was （ 76.3±11.2 ） ° （ range： 73°-98° ）, （ 63.5±15.6 ） ° （ range： 47°-86° ） and （ 16.7±7.3 ） cm （ ragne： 10-26 cm ） respectively. The clinical outcomes and perioperative complications were compared between the 2 groups.Results In group 1, the correction rates of the GK angle, chin-brow vertical angle and SVA were （ 74.2±8.3 ） %, （ 86.2±9.5 ） % and （ 83.6±10.2 ） % respectively. In group 2, the correction rates of the GK angle, chin-brow vertical angle and SVA was （ 70.2±6.5 ） %, （ 86.6±8.3 ） %and （ 88.0±8.7 ） % respectively. As to all the parameters, there were no statistically signiifcant differences between the 2 groups （P〉0.05 ）. But there were statistically signiifcant differences between the 2 groups with regard to the operation time and blood loss （P〈0.05 ）. The patients in group 1 had longer