Wang Yan, Zhang Yonggang, Mao Keya, Zhang Xuesong, Wang Zheng, Zheng Guoquan, Li Gang, Wood Kirkham B
Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.
J Spinal Disord Tech. 2010 May;23(3):186-91. doi: 10.1097/BSD.0b013e3181a5abde.
A prospective study was performed in 8 patients with severe ankylosing spondylitis.
To observe the feasibility, reliability, and complications of a method of transpedicular bivertebrae wedge osteotomy and discectomy to manage the sagittal plane deformity in ankylosing spondylitis with chin-brow vertical angles beyond 90 degrees.
In ankylosing spondylitis, the correction of sagittal plane deformity can be achieved by lengthening the anterior elements, shortening the posterior elements, or a combination of the 2. Neither Smith-Petersen osteotomy, nor pedicle subtraction osteotomy in 1 segment can achieve adequate correction for cases of severe ankylosing spondylitis kyphosis.
From January 2003 to May 2007, 8 patients (3 males and 5 females) with severe ankylosing spondylitis in our institution underwent a single stage transpedicular bivertebrae wedge osteotomy and discectomy. The operation technique includes resection of the posterior elements of 2 adjacent vertebrae, resection of the inferior-posterior aspect of proximal vertebra, and the superior-posterior aspect of the distal vertebra, followed by posterior instrumentation with pedicle screws and spinal fusion. Preoperative and postoperative height, chin-brow vertical angle, sagittal balance, and sagittal Cobb angle of the vertebral osteotomy segment were documented. Intraoperative, postoperative, and general complications were registered.
The mean follow-up was 18.7+/-6.1 months (range: 14 to 54 mo). The mean duration of surgery was 236 minutes (range: 198 to 310 min), and the average volume of intraoperative blood loss was 2200 mL (range: 1600 to 3860 mL). The patients' height increased from 120.5+/-12.0 cm to 159.6+/-12.4 cm (P=0.000). The mean chin-brow vertical angle was improved from 102.8+/-9.7 to 19.3+/-13.9 degrees (P=0.000). The spinal sagittal Cobb angle of the vertebral osteotomy segment was corrected from kyphosis 38.6+/-16.5 degrees to lordosis 26.6+/-10.1 degrees (P=0.000). One patient with the involvement of the cervical spine suffered an extension spinal fracture at C5/6 as the operating table was extended. Translation at the osteotomy site occurred in 1 patient during the correction. Fusion of the osteotomy was achieved in all patients, and no loosening or breakage of pedicle screws was found.
In cases of severe ankylosing spondylitis kyphosis with chin-brow vertical angles beyond 90 degrees, a single stage transpedicular bivertebrae wedge osteotomy and discectomy is an effective corrected method of correction.
对8例重度强直性脊柱炎患者进行了一项前瞻性研究。
观察经椎弓根双椎体楔形截骨术和椎间盘切除术治疗强直性脊柱炎矢状面畸形（颏眉垂直角超过90度）的可行性、可靠性及并发症。
在强直性脊柱炎中，矢状面畸形的矫正可通过延长前方结构、缩短后方结构或两者结合来实现。对于重度强直性脊柱炎后凸畸形病例，单节段的Smith-Petersen截骨术或椎弓根截骨术均无法实现充分矫正。
2003年1月至2007年5月，我院8例重度强直性脊柱炎患者（3例男性，5例女性）接受了一期经椎弓根双椎体楔形截骨术和椎间盘切除术。手术技术包括切除相邻2个椎体的后方结构、近端椎体的后下部分及远端椎体的后上部分，随后用椎弓根螺钉进行后路内固定并植骨融合。记录术前及术后的身高、颏眉垂直角、矢状面平衡及椎体截骨节段的矢状面Cobb角。记录术中、术后及一般并发症。
平均随访时间为18.7±6.1个月（范围：14至54个月）。平均手术时间为236分钟（范围：198至310分钟），术中平均失血量为2200毫升（范围：1600至3860毫升）。患者身高从120.5±12.0厘米增加至159.6±12.4厘米（P = 0.000）。平均颏眉垂直角从102.8±9.7度改善至19.3±13.9度（P = 0.000）。椎体截骨节段的脊柱矢状面Cobb角从后凸38.6±16.5度矫正至前凸26.6±10.1度（P = 0.000）。1例颈椎受累患者在手术台伸展时发生C5/6节段的伸展型脊柱骨折。1例患者在矫正过程中截骨部位出现移位。所有患者截骨处均实现融合，未发现椎弓根螺钉松动或断裂。
对于颏眉垂直角超过90度的重度强直性脊柱炎后凸畸形病例，一期经椎弓根双椎体楔形截骨术和椎间盘切除术是一种有效的矫正方法。
