经椎弓根及椎间盘截骨治疗强直性脊柱炎合并Andersson骨折
|
摘要
目的探索经椎弓根及椎间盘截骨治疗强直性脊柱炎合并Andersson骨折的疗效及可行性。方法 2009年1月—2013年1月,采用经椎弓根及椎间盘截骨术治疗强直性脊柱炎合并Andersson骨折患者17例,所有患者随访>2年。其中男12例,女5例;平均48.7岁;其中9例有明确外伤史,8例无外伤史;9例患者出现渐进性胸腰段脊柱后凸畸形;8例无明显畸形。根据美国脊髓损伤协会(ASIA)评分评估神经损伤等级(E级11例,D级4例,C级2例)。收集所有患者术前及术后X线和CT资料,测量整体后凸角度,局部后凸角度及矢状面平衡。记录患者术前和术后疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。结果所有手术顺利完成,平均手术时间为219 min,术中平均出血量为876 m L。ASIA D级4例恢复到E级;C级1例恢复至E级,1例恢复至D级。术前平均局部后凸从29.1°降低至随访时的5.9°;术前平均整体后凸从59.1°降低至随访时的24.7°。平均矢状面平衡从术前153.7 mm改善至随访时的41.1 mm。平均腰痛VAS评分从术前6.4分下降到随访时的1.1分,平均ODI由术前50.9%改善至随访时的16.9%。所有患者皆获得骨性融合。结论经椎弓根及椎间盘截骨技术可获得满意的矫形效果及良好的融合,是治疗强直性脊柱炎合并Andersson骨折的有效方法。
Objective To explore the efficacy and feasibility of transpedicular and intervertebral disc osteotomy for ankylosing spondylitis(AS) complicated with Andersson fractures. Methods Data of 17 consecutive patients suffering AS complicated with Andersson fractures treated by transpedicular and intervertebral disc osteotomy from January 2009 to January 2013 were analyzed retrospectively. All the patients completed follow-up of at least 2 years. There were 12 males and 5 females,with average age of 48.7 years. Andersson lesion developed after a trauma in 9 patients,and 9 patients complained of progressive thoracolumbar kyphosis. According to American Spinal Injury Association(ASIA) grading system,11 patients were graded as grade E,4 grade D,2 grade C. Radiographic and CT examination data were collected from all the patients before and after surgery,and global angle,regional angle and sagittal vertical axis(SVA) were measured. Clinical outcome data including visual analogue scale(VAS) score and Oswestry Disability Index(ODI) were collected. Results All surgeries were performed successfully. The mean surgical time was 219 min with a mean intraoperative blood loss of 876 m L. Four grade D patients recovered to grade E;in 2 grade C cases,one recovered to grade E,and the other one recovered to grade D. The preoperative mean regional angle was reduced from 29.1° to 5.9° and the preoperative mean global angle was reduced from 59.1° to 24.7° at the time of follow-up. The preoperative mean SVA was reduced from 153.7 mm to 41.1 mm,the preoperative mean back pain VAS score from 6.4 to 1.1 and the preoperative mean ODI from 50.9% to 16.9% at the time of follow-up. Solid fusion was obtained in all the patients. Conclusion Transpedicular and intervertebral disc osteotomy can achieve satisfactory kyphosis correction,good fusion and favorable clinical outcomes,implying an alternative method for AS complicated with Andersson fracture.
Objective To explore the efficacy and feasibility of transpedicular and intervertebral disc osteotomy for ankylosing spondylitis(AS) complicated with Andersson fractures. Methods Data of 17 consecutive patients suffering AS complicated with Andersson fractures treated by transpedicular and intervertebral disc osteotomy from January 2009 to January 2013 were analyzed retrospectively. All the patients completed follow-up of at least 2 years. There were 12 males and 5 females,with average age of 48.7 years. Andersson lesion developed after a trauma in 9 patients,and 9 patients complained of progressive thoracolumbar kyphosis. According to American Spinal Injury Association(ASIA) grading system,11 patients were graded as grade E,4 grade D,2 grade C. Radiographic and CT examination data were collected from all the patients before and after surgery,and global angle,regional angle and sagittal vertical axis(SVA) were measured. Clinical outcome data including visual analogue scale(VAS) score and Oswestry Disability Index(ODI) were collected. Results All surgeries were performed successfully. The mean surgical time was 219 min with a mean intraoperative blood loss of 876 m L. Four grade D patients recovered to grade E;in 2 grade C cases,one recovered to grade E,and the other one recovered to grade D. The preoperative mean regional angle was reduced from 29.1° to 5.9° and the preoperative mean global angle was reduced from 59.1° to 24.7° at the time of follow-up. The preoperative mean SVA was reduced from 153.7 mm to 41.1 mm,the preoperative mean back pain VAS score from 6.4 to 1.1 and the preoperative mean ODI from 50.9% to 16.9% at the time of follow-up. Solid fusion was obtained in all the patients. Conclusion Transpedicular and intervertebral disc osteotomy can achieve satisfactory kyphosis correction,good fusion and favorable clinical outcomes,implying an alternative method for AS complicated with Andersson fracture.
引文
[1]Qian BP,Qiu Y,Wang B,et al.Pedicle subtraction osteotomy through pseudarthrosis to correct thoracolumbar kyphotic deformity in advanced ankylosing spondylitis[J].Eur Spine J,2012,21(4):711-718.
[2]Feldtkeller E,Vosse D,Geusens P,et al.Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis[J].Rheumatol Int,2006,26(3):234-239.
[3]Peh WC,Luk KD.Pseudoarthrosis in ankylosing spondylitis[J].Ann Rheum Dis,1994,53(3):206-210.
[4]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.
[5]Andersson O.Rontgenbilder vid spondylarthritis ankylopoetica[J].Nord Med,1937,14:2000.
[6]Van Royen BJ,Kastelijns RC,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.
[7]Fang D,Leong JC,Ho EK,et al.Spinal pseudarthrosis in ankylosing spondylitis.Clinicopathological correlation and the results of anterior spinal fusion[J].J Bone Joint Surg Br,1988,70(3):443-447.
[8]Shih TT,Chen PQ,Li YW,et al.Spinal fractures and pseudoarthrosis complicating ankylosing spondylitis:MRI manifestation and clinical significance[J].J Comput Assist Tomogr,2001,25(2):164-170.
[9]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.
[10]American Spinal Injury Association.Standards for neurological classification of spinal injury patients[S].Chicago:American Spinal Injury Association,1992.
[11]Huskisson EC.Measurement of pain[J].J Rheumatol,1982,9(5):768-769.
[12]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[13]Kanefield DG,Mullins BP,Freehafer AA,et al.Destructive lesions of the spine in rheumatoid ankylosing spondylitis[J].J Bone Joint Surg Am,1969,51(7):1369-1375.
[14]Debarge R,Demey G,Roussouly P.Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy[J].Eur Spine J,2010,19(1):65-70.
[15]Debarge R,Demey G,Roussouly P.Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis[J].Eur Spine J,2011,20(Suppl 5):619-625.
[16]Kiaer T,Gehrchen M.Transpedicular closed wedge osteotomy in ankylosing spondylitis:results of surgical treatment and prospective outcome analysis[J].Eur Spine J,2010,19(1):57-64.
[17]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.
[18]Chang KW,Tu MY,Huang HH,et al.Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis[J].Spine(Phila Pa 1976),2006,31(13):E408-413.
[19]Chen LH,Kao FC,Niu CC,et al.Surgical treatment of spinal pseudoarthrosis in ankylosing spondylitis[J].Chang Gung Med J,2005,28(9):621-628.
[20]Zheng GQ,Song K,Zhang YG,et al.Two-level spinal osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis.Experience with 48 patients[J].Spine(Phila Pa 1976),2014,39(13):1055-1058.
[21]王岩,毛克亚,张永刚,等.双椎体截骨术矫正重度强直性脊柱炎后凸畸形[J].中国脊柱脊髓杂志,2009,19(2):108-112.
[22]张永刚,李明,朱泽章,等.如何认识成人脊柱畸形矫形中矢状面的平衡?[J].中国脊柱脊髓杂志,2012,22(3):196-200.
[23]宋凯,张永刚.强直性脊柱炎胸腰段后凸畸形矫形设计概述[J].解放军医学院学报,2015,36(5):521-524.
[24]Bridwell KH.Decision making regarding Smith-Petersen vs.pedicle subtraction osteotomy vs.vertebral column resection for spinal deformity[J].Spine(Phila Pa 1976),2006,31(19Suppl):S171-178.
[2]Feldtkeller E,Vosse D,Geusens P,et al.Prevalence and annual incidence of vertebral fractures in patients with ankylosing spondylitis[J].Rheumatol Int,2006,26(3):234-239.
[3]Peh WC,Luk KD.Pseudoarthrosis in ankylosing spondylitis[J].Ann Rheum Dis,1994,53(3):206-210.
[4]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.
[5]Andersson O.Rontgenbilder vid spondylarthritis ankylopoetica[J].Nord Med,1937,14:2000.
[6]Van Royen BJ,Kastelijns RC,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.
[7]Fang D,Leong JC,Ho EK,et al.Spinal pseudarthrosis in ankylosing spondylitis.Clinicopathological correlation and the results of anterior spinal fusion[J].J Bone Joint Surg Br,1988,70(3):443-447.
[8]Shih TT,Chen PQ,Li YW,et al.Spinal fractures and pseudoarthrosis complicating ankylosing spondylitis:MRI manifestation and clinical significance[J].J Comput Assist Tomogr,2001,25(2):164-170.
[9]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.
[10]American Spinal Injury Association.Standards for neurological classification of spinal injury patients[S].Chicago:American Spinal Injury Association,1992.
[11]Huskisson EC.Measurement of pain[J].J Rheumatol,1982,9(5):768-769.
[12]Fairbank JC,Couper J,Davies JB,et al.The Oswestry low back pain disability questionnaire[J].Physiotherapy,1980,66(8):271-273.
[13]Kanefield DG,Mullins BP,Freehafer AA,et al.Destructive lesions of the spine in rheumatoid ankylosing spondylitis[J].J Bone Joint Surg Am,1969,51(7):1369-1375.
[14]Debarge R,Demey G,Roussouly P.Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy[J].Eur Spine J,2010,19(1):65-70.
[15]Debarge R,Demey G,Roussouly P.Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis[J].Eur Spine J,2011,20(Suppl 5):619-625.
[16]Kiaer T,Gehrchen M.Transpedicular closed wedge osteotomy in ankylosing spondylitis:results of surgical treatment and prospective outcome analysis[J].Eur Spine J,2010,19(1):57-64.
[17]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.
[18]Chang KW,Tu MY,Huang HH,et al.Posterior correction and fixation without anterior fusion for pseudoarthrosis with kyphotic deformity in ankylosing spondylitis[J].Spine(Phila Pa 1976),2006,31(13):E408-413.
[19]Chen LH,Kao FC,Niu CC,et al.Surgical treatment of spinal pseudoarthrosis in ankylosing spondylitis[J].Chang Gung Med J,2005,28(9):621-628.
[20]Zheng GQ,Song K,Zhang YG,et al.Two-level spinal osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis.Experience with 48 patients[J].Spine(Phila Pa 1976),2014,39(13):1055-1058.
[21]王岩,毛克亚,张永刚,等.双椎体截骨术矫正重度强直性脊柱炎后凸畸形[J].中国脊柱脊髓杂志,2009,19(2):108-112.
[22]张永刚,李明,朱泽章,等.如何认识成人脊柱畸形矫形中矢状面的平衡?[J].中国脊柱脊髓杂志,2012,22(3):196-200.
[23]宋凯,张永刚.强直性脊柱炎胸腰段后凸畸形矫形设计概述[J].解放军医学院学报,2015,36(5):521-524.
[24]Bridwell KH.Decision making regarding Smith-Petersen vs.pedicle subtraction osteotomy vs.vertebral column resection for spinal deformity[J].Spine(Phila Pa 1976),2006,31(19Suppl):S171-178.