主动脉牵拉后的顺应性和强直性脊柱炎脊柱后凸矫正的关系

目的 :探讨强直性脊柱炎 (AS)脊柱后凸矫正术的适应症与主动脉钙化的关系。方法 :① 6例新鲜尸体主动脉按 10 %、15 %、2 0 %、2 5 %、30 %和 35 %牵拉后的力学变化 ,用压力换能器在生理二道记录仪上记下压力值 ,作组织切片 ,光镜观察 ;② 30例高血压主动脉钙化硬化病人在核磁共振下动态由弯腰变伸直进行弯腰试验 ;③ 41例AS合并主动脉钙化患者 ,脊柱后矫正前后行X线观察主动脉与椎体相对位移情况。结果 :主动脉受牵拉超过原长的 2 0 %会产生血管损伤 ,而牵拉在 15 %以内则无血管损伤 ;弯腰试验主动脉与椎体无移位 ;主动脉钙化者 ,矫正术后均未发现主动脉损伤征象。结论 :对AS脊柱后凸合并主动脉钙化患者 ,只要术中对主动脉的牵拉限制在 2 0 %以内脊柱矫形术是安全的。术中采用控制性低血压可以增加主动脉顺应性。

Stretch of thoracolumbar aortia and correction of kyphotic deformity in ankylosing spondylitis

Objective:To discuss the relationship between the thoracolumbar aortic calcification and the correction of kyphotic deformity in ankylosing spondylitis (AS).Methods:The biomechanical change of normal thoracolumbar aortia from fresh cadaver under different stretch was calculated in vitro.By the measure pressure volume ralationship.The change of thoracolumbar aortia were observed on thirty hypertension patient with aortic calcification through MRI in addition,the relative position between thoracolumbar aortia and vertebral body was observed before and after kyphotic orthopedia on X ray pictures of 41 AS patients with aortic calcification.Results:It showed that stretch over 20% of thoracolumbar aortia length would damage the aortia,but less than 15% was safe.Meanwhile,it was found that the thoracolumbar aortia of the AS patients could be straightened safely without changing the ralative distance,if the anterior longitudiual ligament of the spine remained intact.Conclusions:The correction of kyphotic deformity in AS patient with aortic calcifiction is safe,if the strech of aortia was controlled within 20%.