经椎弓根楔形截骨矫正强直性脊柱炎后凸畸形

目的研究经腰椎椎弓根楔形截骨矫正强直性脊柱炎后凸畸形的手术方法和治疗效果。方法2003年1月~2006年12月收治12例男性强直性脊柱炎后凸畸形患者,平均年龄36岁。手术采用一期后路经L3椎弓根截骨矫形,截骨节段上方和下方至少2个节段椎弓根螺钉矫正固定。测量患者术前和术后颌眉线/垂线夹角和脊柱侧位X线L2~4椎体Cobb角度。结果患者颌眉线/垂线夹角由术前平均76.3°矫正到术后平均17°,而L2~4的Cobb角度由术前平均后凸6.7°矫正到术后平均前凸48.6°。所有患者能够平视行走,矢状面平衡和步态得到明显改善。结论对于严重强直性脊柱炎后凸畸形患者,经腰椎椎弓根楔形截骨矫形是一种安全有效的治疗方法。

Transpedicular wedge resection osteotomy for correction of kyphotic deformity in ankylosing spondylitis

Objective To retrospective analyze the surgical treatment and clinical results of transpedicular lumbar wedge resection osteotomy for correction of kyphotic deformity in ankylosing spondylitis. Methods From 2003 Jan to 2006 Dec, 12 male patients of ankylosing spondylitis kyphotic deformity with mean age 36 years old has received surgical treatment. One stage posterior transpedicular wedge resection osteotomy was performed through L₃ vertebrae, and at least two segments distal and proximal to L₃ were instrumented. The results were evaluated by measuring the preoperative and postoperative Chin-brow vertical angle and Cobb angle from L₂ to L4 in the lateral spinal X-ray film. Results The mean Chin-brow vertical angle was corrected from preoperative 76.3° to postoperative 17°, and the lateral L_2-4 Cobb angle was corrected from 6.7° to 48.6°. All patients can walk with forward vision and sagittal balance and gait were improved significantly. Conclusion Lumbar transpedicular wedge osteotomy was a safe and effective surgical treatment to the severe ankylosing spondylitis kyphosis.