强直性脊柱炎后凸畸形矫形前后 生活质量与影像学参数分析

  目的 进行强直性脊柱炎(ankylosing spondylitis, AS)僵硬性胸腰段后凸畸形矫形前后影 像学参数与主观评分的相关性研究。 方法2004 年1 月至2010 年3 月, 对收治的38 例无脊髓神经症 状与体征、双髋活动良好的AS 僵硬性胸腰段后凸畸形患者, 行后路单节段或双节段经椎弓根截骨矫形 椎弓根螺钉内固定术。男24例, 女14 例;年龄22~57 岁, 平均35 岁。测量AS 患者矫形前后身高、颌眉 角、屈膝角、全脊柱后凸角(Cobb T1~S1)、骨盆入射角(pelvic incidence, PI)、骨盆倾斜角(pelvic title, PT)、 骶骨倾斜角(sacral slope, SS)、矢状面平衡距离(sagittal vertical axis, SVA), 记录患者矫形前后Oswestry 功能障碍指数(Oswestry disability index, ODI)、脊柱侧凸研究会-22 项问卷(scoliosis research society-22, SRS-22)评分。分析矫形前后外观、影像学参数及主观评分变化;控制影响患者个体差异的因素, 将影像 学参数及主观评分行偏相关分析。 结果 患者矫形后外观、生存质量、活动能力、心理状态趋于正常; Cobb T1~S1、SVA及骨盆位置性参数(PT、SS)显著改善。矫形前Cobb T1~S1、PT、SS、SVA 与ODI 行走、站 立分项呈偏相关。矫形后PT、SS 与ODI 总分、行走、站立呈偏相关, 但Cobb T1~S1、SVA 与ODI 总分、行 走、站立不呈偏相关。 结论 骨盆后旋状态导致AS 后凸畸形患者直立活动能力下降, 确保骨盆中立位 是矢状面平衡重建的最终目标。

Analysis on correlation of radiographic parameters and quality of life before and after kyphosis correction in ankylosing spondylitis

Objective To investigate the correlation of radiographic parameters and health-related quality of life (HRQOL) instruments before and after thoracolumbar kyphosis correction in ankylosing spondylitis (AS) kyphosis. Methods Thirty-eight AS patients with fixed thoracolumbar kyphosis were treated with pedicle subtraction osteotomies (PSO) in our hospital from January 2004 to March 2010. Pre-and post-operative radiological parameters, Cobb T1-S1, pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sagittal vertical axis (SVA) were measured. The Oswestry disability index (ODI) and scoliosis research society-22 (SRS-22) questionnaire were used to evaluate the clinical results. Statistical correlation analysis was made to determine correlation between radiographic parameters and overall or partial specific scores of HRQOL instruments. Results The life quality and related radiological spino-pelvic parameters were improved significantly after operation. Preoperatively, Cobb T1-S1, PT, SS, and SVA had partial correlation with ODI walking score and ODI standing score; postoperatively, only PT and SS had partial correlation with ODI. Conclusion Pelvic positional parameters are the key parameters for upright activities, and making pelvis in a neutral position is the ultimate goal of surgery.