Hehne H J, Zielke K, Böhm H
Department of Surgery, University of Freiburg, Federal Republic of Germany.
Clin Orthop Relat Res. 1990 Sep(258):49-55.
Despite conservative therapy in ankylosing spondylitis, kyphotic deformities are common. Mono-segmental lumbar osteotomy had a high complication rate. Therefore, a poly-segmental lordosis osteotomy of the lumbar spine was introduced in four to six segments using trans-pedicled screws and threaded rods in eight to ten segments (isolated correction is possible for each segment). Instead of dangerous short kinking, a poly-segmental lordosis osteotomy results in harmonious lordosis with a correction per segment of about 10 degrees, and complications are decreased. Of 177 patients undergoing the operation, there was a 2.3% mortality rate with cardiopulmonary problems, 2.3% with irreversible complications, and 18.1% with reversible complications, mostly small root lesions, of which 7% were reoperated. The 173 surviving patients had a correction of 43%, and improvement in body height of 9 cm, and improvement of flexion by 57%. Fifty-three patients have been followed for more tha 18 months. the visual axis in all cases was horizontal. No pseudoarthrosis occurred. After correction, the frequent spondylodiscitis healed. Ninety-two percent were pain free compared with 15% before the operation. Loss of correction of body height was 20%, of flexion 4%, and of the lordosis 7%, which was 18% in 37 patients after three years.
尽管强直性脊柱炎采用了保守治疗，但后凸畸形仍很常见。单节段腰椎截骨术的并发症发生率较高。因此，引入了多节段腰椎前凸截骨术，在四到六个节段进行，使用八到十个节段的椎弓根螺钉和螺纹杆（每个节段可单独矫正）。多节段腰椎前凸截骨术不会出现危险的短缩扭结，而是能形成和谐的前凸，每个节段的矫正角度约为10度，并发症也有所减少。在接受该手术的177例患者中，因心肺问题导致的死亡率为2.3%，不可逆并发症的发生率为2.3%，可逆并发症的发生率为18.1%，主要是小的神经根损伤，其中7%的患者接受了再次手术。173例存活患者的矫正率为43%，身高增加9厘米，前屈改善57%。53例患者随访超过18个月。所有病例的视轴均为水平。未发生假关节。矫正后，常见的脊椎椎间盘炎愈合。92%的患者术后无痛，而术前这一比例为15%。身高矫正丢失率为20%，前屈丢失率为4%，脊柱前凸丢失率为7%，3年后37例患者的脊柱前凸丢失率为18%。
