后路顶椎区多节段水平式脊柱截骨术治疗强直性脊柱炎后凸畸形

目的 通过后路多节段顶椎区水平式截骨治疗强直性脊柱炎（AS）后凸畸形，观察并评价这一手术方法的疗效。方法对14例AS后凸畸形患者年龄平均33岁；身高（156．64±6．78）cm；矢状面不同节段Cobb角：T5-1283．00°±10.29°，T11～L237．00°±10.51°，L1-514．000±4．85°；后凸Cobb角：T10～L248．60°±15.62°；躯干后凸角（WBKA角）：53．30°±11.09°]采用顶椎区多个节段水平式脊柱截骨的方法来矫正后凸畸形。内固定均采用椎弓根螺钉技术。结果术后患者身高平均增长（8．70±2．05）cm（P〈0．01）。矢状面不同节段Cobb角：T5-1243．20°±9．04°，矫正39．80°±4．17°（P〈0．01）；T11～L23．80°±1．53°，矫正33．20＋4.74°（P〈0．01）；L1-5 32.80°±6．81°，矫正18．79°±6．99°（P〈0．01）。后凸Cobb角：T10-L25．60°±1．68°，矫正43.00°±10．09°（P〈0．01）。WBKA角8．30°±3.10°，矫正44．18°＋7．17°（P〈0．01）。均无明显神经症状。术后随访0．5～2年，截骨部位在6～12个月时出现椎体间和椎板的骨性融合，外形明显改善，心肺功能好转。结论顶椎区多节段水平式脊柱截骨治疗脊柱后凸畸形疗效良好，同传统的Lt以下椎体楔形截骨比较，有明显的优点，但不适用于椎体前缘有明显骨性融合的患者。

Ankylosing spondylitis with kyphosis treated with posterior multiple-segmental horizontal osteotomy

Objective To evaluate the posterior multiple-segmental horizontal osteotomy in treatment of ankylosing spondylitis （AS） with kyphosis. Methods Fourteen AS patients with kyphosis underwent posterior multiple-segmental horizontal osteotomy. The mean preoperative height of patients was （156.64 ± 6.78）cm. The mean preoperative sagittal kyphosis Cobb＇s angles of T5-12, T11- L2, L1-5 and T10-L2 were 83.00± 10.29°, 37.00° ±10.51°, 14.00° ± 4.85° and 48.6° ± 15.62°, respectively. The mean whole body kyphosis angle （WBKA） was 53.30°± 11.09° Internal fixation with pedicle screws was performed in all the patients. Intraoperative neuromonitor with sensory evoked potentials and motor evoked potentials was used. Results After operation the mean height of the patients increased by （ 8.70 ±2.05 ）cm （ 163.93± 6.31 ）cm vs （ 156.64 ± 6.78 ）cm, P〈0.01 ）]. The mean postoperative sagittal kyphosis Cobb＇s angles of T5-12, T11- L2, L5-12 and T10-L2 were 43.20° ± 9.04°, 3.80°± 1.53°, 32.80° ± 6.81° and 5.60° ± 1.68° respectively; and the corrections for T5-12, T11 - L2, L1-5 and T10-L2 were 39.80° _＋ 4.17°（ P〈0.01 ）, 33.20° ± 4.74°（ P〈0.01 ） ,18.79°±6.99°（P〈0.01） and 43.00°±10.09°（P〈0.01） respectively. The mean WBKA was 8.30° ±3.10° and the correction was 44.18°±7.17°（P〈0.01）. The mean duration of followed up was 6-24 months, and synostosis took place at the position of osteotomy after 6-12 months. The appearance and the cardiopulmonary function of patients were considerably improved after the surgery. Conclusion Posterior multiple-segmental horizontal osteotomy is an effective procedure for ankylosing spondylitis with kyphosis, but it is not suitable for patients with apparent anterior bony synostosis.