一期后路病灶清除椎间植骨内固定治疗强直性脊柱炎Andersson病变的疗效观察
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摘要
目的探讨一期后路病灶清除椎间植骨内固定对强直性脊柱炎Andersson病变的治疗疗效。方法回顾性分析2008年1月至2014年7月,于我院确诊为强直性脊柱炎Andersson病变且采用一期后路病灶清除椎间植骨内固定治疗的患者9例,均为男性,年龄39~67岁,平均(52.6±7.5)岁。病变节段:T_(10~11) 1例,T_(11~12) 7例,T_(12)~L_1 1例。Frankel分级:C级6例,D级3例。评估获得随访患者的手术时间、出血量,手术前后VAS评分、Frankel评分及病变节段后凸Cobb’s角改善情况。结果所有患者均获随访,随访时间24~56个月,平均(32.8±8.75)个月,手术时间105~175 min,平均(133.9±25.3)min,失血量450~850 ml,平均(596.7±146.3)ml。术后3个月VAS评分平均为(2.80±0.43),较术前(8.53±1.11)显著降低,差异有统计学意义(P<0.05);术后24个月VAS评分平均为(1.60±0.45),较术后3个月显著降低,差异有统计学意义(P<0.05)。术后24个月Frankel评分:D级2例,E级7例。术后3个月Cobb’s角为(15.2±3.73)°,较术前(28.3±5.93)°明显改善,差异有统计学意义(P<0.05),且在术后24个月时(15.6±4.09)°矫正角度无明显丢失(P>0.05)。所有植骨均发生融合,融合时间6~13个月,平均8.6个月。结论一期后路病灶清除椎间植骨内固定可有效去除Andersson病变、恢复正常脊柱序列及显著改善患者神经功能。
Objective To investigate the clinical results of one-stage posterior debridement, interbody bone graft and internal fixation for Andersson lesion in the patients with ankylosing spondylitis( AS). Methods The clinical data of 9 cases of AS complicated with Andersson lesion who underwent one-stage posterior debridement, interbody bone graft and internal fixation from January 2008 to July 2014 were retrospectively analyzed. They were all males, whose mean age was( 52.6 ± 7.5) years( range: 39-67 years). As to the lesion segment, there was 1 case of T_(10-11), 7 cases of T_(11-12) and 1 case of T_(12)-L_1. As to the preoperative Frankel grade, there were 6 cases of Grade C and 3 cases of Grade D. The operation time, blood loss, preoperative and postoperative visual analogue scale( VAS) scores, Frankel grade and Cobb's angle improvement of the lesion segment were measured to evaluate the therapeutic effects. Results All the patients were followed up for an average period of( 32.8 ± 8.75) months( range: 24-56 months). The mean operative time was( 133.9 ± 25.3) min( range: 105-175 min), and the average blood loss was( 596.7 ± 146.3) ml( range: 450-850 ml). The mean VAS score at 3 months after the operation was( 2.80 ± 0.43), which was obviously lower than( 8.53 ± 1.11) before the operation, and the differences were statistically significant( P < 0.05). The mean VAS score at 24 months after the operation was( 1.60 ± 0.45), which was obviously lower than that at 3 months after the operation, and the differences were statistically significant( P < 0.05). The Frankel grade distribution at 24 months after the operation: 2 cases of grade D and 7 cases of grade E. The mean Cobb's angle at 3 months after the operation was( 15.2 ± 3.73) °, which was lower than( 28.3 ± 5.93) ° before the operation, and the differences were statistically significant( P < 0.05). The mean Cobb's angle at 24 months after the operation maintained at the level of( 15.6 ± 4.09) °( P > 0.05). All the cases acquired bone fusion, and the mean fusion time was 8.6 months( range: 6-13 months). Conclusions One-stage posterior debridement, interbody bone graft and internal fixation can effectively remove the lesion, restore normal spinal alignment and significantly improve neurological functions for the AS patients complicated with Andersson lesion.
Objective To investigate the clinical results of one-stage posterior debridement, interbody bone graft and internal fixation for Andersson lesion in the patients with ankylosing spondylitis( AS). Methods The clinical data of 9 cases of AS complicated with Andersson lesion who underwent one-stage posterior debridement, interbody bone graft and internal fixation from January 2008 to July 2014 were retrospectively analyzed. They were all males, whose mean age was( 52.6 ± 7.5) years( range: 39-67 years). As to the lesion segment, there was 1 case of T_(10-11), 7 cases of T_(11-12) and 1 case of T_(12)-L_1. As to the preoperative Frankel grade, there were 6 cases of Grade C and 3 cases of Grade D. The operation time, blood loss, preoperative and postoperative visual analogue scale( VAS) scores, Frankel grade and Cobb's angle improvement of the lesion segment were measured to evaluate the therapeutic effects. Results All the patients were followed up for an average period of( 32.8 ± 8.75) months( range: 24-56 months). The mean operative time was( 133.9 ± 25.3) min( range: 105-175 min), and the average blood loss was( 596.7 ± 146.3) ml( range: 450-850 ml). The mean VAS score at 3 months after the operation was( 2.80 ± 0.43), which was obviously lower than( 8.53 ± 1.11) before the operation, and the differences were statistically significant( P < 0.05). The mean VAS score at 24 months after the operation was( 1.60 ± 0.45), which was obviously lower than that at 3 months after the operation, and the differences were statistically significant( P < 0.05). The Frankel grade distribution at 24 months after the operation: 2 cases of grade D and 7 cases of grade E. The mean Cobb's angle at 3 months after the operation was( 15.2 ± 3.73) °, which was lower than( 28.3 ± 5.93) ° before the operation, and the differences were statistically significant( P < 0.05). The mean Cobb's angle at 24 months after the operation maintained at the level of( 15.6 ± 4.09) °( P > 0.05). All the cases acquired bone fusion, and the mean fusion time was 8.6 months( range: 6-13 months). Conclusions One-stage posterior debridement, interbody bone graft and internal fixation can effectively remove the lesion, restore normal spinal alignment and significantly improve neurological functions for the AS patients complicated with Andersson lesion.
引文
[1]Werner BC,Samartzis D,Shen FH.Spinal fractures in patients with ankylosing spondylitis:etiology,diagnosis,and management[J].J Am Acad Orthop Surg,2016,24(4):241-249.
[2]Cawley MI,Chalmers TM,Ball J.Destructive lesions of vertebral bodies in ankylosing spondylitis[J].Ann Rheum Dis,1972,31(5):345-358.
[3]Russo VM,Casey AT.Andersson lesion in ankylosing spondylitis[J].Spine J,2014,14(7):1357.
[4]李国,李家顺,贾连顺,等.强直性脊柱炎并发椎间假关节形成的病理病因和治疗[J].中国脊柱脊髓杂志,2003,13(12):727-730.
[5]Zochling J,Heijde DVD,Burgosvargas R,et al.ASAS/EULAR recommendations for the management of ankylosing spondylitis[J].Ann Rheum Dis,2009,65(4):442-452.
[6]钱邦平,邱勇,王斌,等.强直性脊柱炎患者胸腰椎应力骨折的临床及影像学特点[J].中国脊柱脊髓杂志,2008,18(10):747-751.
[7]Park YS,Kim JH,Ryu JA,et al.The Andersson lesion in ankylosing spondylitis:distinguishing between the inflammatory and traumatic subtypes[J].J Bone Joint Surg Br,2011,93(7):961-966.
[8]Simmons EH,Goodwin CB.Spondylodiscitis:A manifestation of ankylsoing spondylitis[J].Orthop Transactions,1984,8(1):165-169.
[9]Zhang W,Zheng M.Operative strategy for different types of thoracolumbar stress fractures in ankylosing spondylitis[J].J Spinal Dis Tech,2014,27(8):423-430.
[10]Pettersson T,Laasonen L,Leirisalo-Repo M,et al.Spinal pseudoarthrosis complicating ankylosing spondylitis:a report of two patients[J].Br J Rheumatol,1996,35(12):1319-1323.
[11]Rasker JJ,Prevo RL,Lanting PJ.Spondylodiscitis in ankylosing spondylitis,inflammation or trauma?A description of six cases[J].Scand J Rheumatol,1996,25(1):52-57.
[12]Hermann KG,Althoff CE,Schneider U,et al.Spinal changes in patients with spondyloarthritis:comparison of MR imaging and radiographic appearances[J].Radiographics,2005,25(3):559-569.
[13]刘家明,沈建雄,余可谊.强直性脊柱炎合并Andersson损害误诊为脊柱结核1例报道并文献复习[J].中国骨与关节外科,2012,5(3):261-264.
[14]Naqi R,Ahsan H,Azeemuddin M.Spinal changes in patients with ankylosing spondylitis on MRI:case series[J].J Pak Med Assoc,2010,60(10):872-875.
[15]刘晖,王岩.强直性脊柱炎Andersson椎体椎间盘病变研究进展[J].中国骨与关节损伤杂志,2012,27(5):476-478.
[16]Dave BR,Ram H,Krishnan A.Andersson lesion:are we misdiagnosing it?A retrospective study of clinico-radiological features and outcome of short segment fixation[J].Eur Spine J,2011,20(9):1503-1509.
[17]Bron JL,de Vries MK,Snieders MN,et al.Discovertebral(Andersson)lesions of the spine in ankylosing spondylitis revisited[J].Clin Rheumatol,2009,28(8):883-892.
[18]Rivelis M,Freiberger RH.Vertebral destruction at unfused segments in late ankylosing spondylitis[J].Radiology,1969,93(2):251-256.
[19]Van Royen BJ,Kastelijns RCA,Noske DP,et al.Transpedicular wedge resection osteotomy for the treatment of a kyphotic Andersson lesion-complicating ankylosing spondylitis[J].Eur Spine J,2006,15(2):246-252.
[20]Zhang X,Wang Y,Wu B,et al.Treatment of Andersson lesion-complicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy,a retrospective study[J].Eur Spine J,2016,25(8):2587-2595.
[21]王尧,张雪松,胡文浩,等.经椎弓根及椎间盘截骨治疗强直性脊柱炎合并Andersson骨折[J].脊柱外科杂志,2016,14(2):65-69.
[22]王红强,高延征,余正红,等.后路360°植骨融合治疗强直性脊柱炎胸腰椎应力骨折的临床研究[J].中国现代医学杂志,2016,26(3):126-130.
[2]Cawley MI,Chalmers TM,Ball J.Destructive lesions of vertebral bodies in ankylosing spondylitis[J].Ann Rheum Dis,1972,31(5):345-358.
[3]Russo VM,Casey AT.Andersson lesion in ankylosing spondylitis[J].Spine J,2014,14(7):1357.
[4]李国,李家顺,贾连顺,等.强直性脊柱炎并发椎间假关节形成的病理病因和治疗[J].中国脊柱脊髓杂志,2003,13(12):727-730.
[5]Zochling J,Heijde DVD,Burgosvargas R,et al.ASAS/EULAR recommendations for the management of ankylosing spondylitis[J].Ann Rheum Dis,2009,65(4):442-452.
[6]钱邦平,邱勇,王斌,等.强直性脊柱炎患者胸腰椎应力骨折的临床及影像学特点[J].中国脊柱脊髓杂志,2008,18(10):747-751.
[7]Park YS,Kim JH,Ryu JA,et al.The Andersson lesion in ankylosing spondylitis:distinguishing between the inflammatory and traumatic subtypes[J].J Bone Joint Surg Br,2011,93(7):961-966.
[8]Simmons EH,Goodwin CB.Spondylodiscitis:A manifestation of ankylsoing spondylitis[J].Orthop Transactions,1984,8(1):165-169.
[9]Zhang W,Zheng M.Operative strategy for different types of thoracolumbar stress fractures in ankylosing spondylitis[J].J Spinal Dis Tech,2014,27(8):423-430.
[10]Pettersson T,Laasonen L,Leirisalo-Repo M,et al.Spinal pseudoarthrosis complicating ankylosing spondylitis:a report of two patients[J].Br J Rheumatol,1996,35(12):1319-1323.
[11]Rasker JJ,Prevo RL,Lanting PJ.Spondylodiscitis in ankylosing spondylitis,inflammation or trauma?A description of six cases[J].Scand J Rheumatol,1996,25(1):52-57.
[12]Hermann KG,Althoff CE,Schneider U,et al.Spinal changes in patients with spondyloarthritis:comparison of MR imaging and radiographic appearances[J].Radiographics,2005,25(3):559-569.
[13]刘家明,沈建雄,余可谊.强直性脊柱炎合并Andersson损害误诊为脊柱结核1例报道并文献复习[J].中国骨与关节外科,2012,5(3):261-264.
[14]Naqi R,Ahsan H,Azeemuddin M.Spinal changes in patients with ankylosing spondylitis on MRI:case series[J].J Pak Med Assoc,2010,60(10):872-875.
[15]刘晖,王岩.强直性脊柱炎Andersson椎体椎间盘病变研究进展[J].中国骨与关节损伤杂志,2012,27(5):476-478.
[16]Dave BR,Ram H,Krishnan A.Andersson lesion:are we misdiagnosing it?A retrospective study of clinico-radiological features and outcome of short segment fixation[J].Eur Spine J,2011,20(9):1503-1509.
[17]Bron JL,de Vries MK,Snieders MN,et al.Discovertebral(Andersson)lesions of the spine in ankylosing spondylitis revisited[J].Clin Rheumatol,2009,28(8):883-892.
[18]Rivelis M,Freiberger RH.Vertebral destruction at unfused segments in late ankylosing spondylitis[J].Radiology,1969,93(2):251-256.
[19]Van Royen BJ,Kastelijns RCA,Noske DP,et al.Transpedicular wedge resection osteotomy for the treatment of a kyphotic Andersson lesion-complicating ankylosing spondylitis[J].Eur Spine J,2006,15(2):246-252.
[20]Zhang X,Wang Y,Wu B,et al.Treatment of Andersson lesion-complicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy,a retrospective study[J].Eur Spine J,2016,25(8):2587-2595.
[21]王尧,张雪松,胡文浩,等.经椎弓根及椎间盘截骨治疗强直性脊柱炎合并Andersson骨折[J].脊柱外科杂志,2016,14(2):65-69.
[22]王红强,高延征,余正红,等.后路360°植骨融合治疗强直性脊柱炎胸腰椎应力骨折的临床研究[J].中国现代医学杂志,2016,26(3):126-130.