经关节突“V”形截骨与经椎弓根椎体截骨对脊柱-骨盆复合体平衡的影响

 目的 比较多节段经关节突“V”形截骨(Smith-Petersen osteotomies，SPOs)与经椎弓根椎体截骨(pedicle subtraction osteotomy，PSO)重建强直性脊柱炎胸腰椎后凸畸形患者脊柱-骨盆复合体平衡的效果。方法 2000年8月至2010年6月应用SPOs或PSO矫形内固定术治疗39例强直性脊柱炎胸腰椎后凸畸形患者。SPOs组15例，男13例，女2例；年龄18~42岁，平均(28.1±7.1)岁。PSO组24例，男20例，女4例；年龄21~53岁，平均(38.3±7.9)岁。比较两组患者术前、术后3个月及末次随访的脊柱-骨盆参数：胸椎后凸角(thoracic kyphosis，TK)、腰椎前凸角(lumbar lordosis，LL)、全脊柱最大后凸Cobb角(global kyphosis，GK)、矢状面平衡(sagittal vertical axis，SVA)、骨盆投射角(pelvic incidence，PI)、骶骨倾斜角(sacral slope，SS)和骨盆倾斜角(pelvic tilting，PT)。结果 除TK和PI外，其他参数手术前后比较差异均有统计学意义。术前测量指标除PI、GK及LL外，其他参数两组间比较差异均无统计学意义；术后LL、GK、PT及SS两组间比较差异有统计学意义。末次随访时，SVA、LL、GK、PT及SS的矫正丢失两组间比较差异有统计学意义。结论 对强直性脊柱炎胸腰椎后凸畸形患者，PSO能够获得更好的脊柱-骨盆复合体平衡重建，而SPOs易于发生远期矫正度丢失。

Comparison of sagittal reconstruction in ankylosing spondylitis patients with kyphosis: Smith-Petersen osteotomies versus pedicle subtraction osteotomy

Objective To compare the effects of Smith-Petersen osteotomies (SPOs) and pedicle subtraction osteotomy (PSO) on sagittal alignment in patients with thoracolumbar kyphosis secondary to ankylosing spondylitis(AS). Methods The data of the 39 patients with ankylosing spondylitis of thoracic and lumbar kyphosis were retrospectively reviewed, who received SPOs or PSO orthopedic internal fixation from August 2000 to June 2010. According to the types of osteotomies, the 39 patients were categorized into 2 groups. Of them, 15 patients including 13 males and 2 females comprised the SPOs group, whose average age was 28.1±7.1 years, ranging from 18 to 42, whereas the other 24 patients including 20 males and 4 females comprised the PSO group, whose average age was 38.3±7.9 years, ranging from 21 to 53. Radiographic parameters were measured and compared between the two groups including thoracic kyphosis (TK), lumbar lordosis (LL), global kyphosis (GK), sagittal imbalance (SVA), pelvic incidence (PI), sacral slope (SS), and pelvic tilting (PT) before the operation, 3 months after the operation, and at the last follow-up, respectively. Results Significant differences were found in terms of the improvement of LL, PT, SS, SVA and GK except that of TK and PI. Preoperatively, no significant difference was found between the two groups in TK, SVA, PT and SS except PI, GK and LL. Postoperatively, significant differences were found between the two groups in LL, GK, PT and SS. Significant differences were found between the two groups in the mean loss of correction of GK, LL, SVA, PT and SS at the last follow-up. Conclusion For patients with ankylosing spondylitis of thoracic and lumbar kyphosis, satisfactory reconstruction of spino-pelvic alignment can be obtained by PSO, whereas loss of correction occurred frequently in SPOs.