Wang Fei, Tao Huiren, Liu Zhibin, Zhang Jianhua, Han Fangmin
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Feb;29(2):184-8.
To introduce the application of Photoshop CS16.0 (PS) software in preoperative osteotomy design of ankylosing spondylitis kyphosis (ASK), and to investigate applied values of the preoperative design.
Between March 2009 and March 2013, 21 cases of ASK were treated through preoperative osteotomy design by using PS software. There were 16 males and 5 females, aged from 23 to 50 years (mean, 34.2 years). The deformity included thoracolumbar kyphosis in 14 cases, thoracic kyphosis in 2 cases, and lumbar kyphosis in 5 cases. The ultimate osteotomy angle of preoperative plans and the location and extent of osteotomy were determined by the osteotomy design, which guided operation procedures of the surgeon. The actual osteotomy angle was obtained by measuring Cobb angle of osteotomy segment before and after operation. The sagittal parameters of spine and pelvis including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and chin brow-vertical angle (CBVA) were measured at preoperation, at 1 week after operation, and last follow-up. The clinical outcomes were assessed by simplified Chinese Scoliosis Research Society-22 (SRS-22) questionnaire and Oswestry disability index (ODI).
No complications occurred in the other cases except 1 case of dural tear during operation and 1 case of nerve injury after operation, and primary healing of incision was obtained. All patients were followed up 14 to 45 months (mean, 26.3 months). The SRS-22 and ODI scores at 1 week after operation and last follow-up were significantly improved when compared with preoperative scores (P < 0.05), but no significant difference was found between at 1 week and last follow-up (P > 0.05). The preoperative planned osteotomy angle and the postoperative actual osteotomy angle were (34.2 ± 10.5) degrees and (33.7 ± 9.7) degrees respectively, showing no significant difference (t = 0.84, P = 0.42). The CBVA, GK, SVA, PT, and LL were significantly improved when compared with the preoperative values (P < 0.05), but no significant difference was found between at 1 week and last follow-up (P > 0.05). At last follow-up, no failures of internal fixation was found, and bony fusion was obtained.
The preoperative osteotomy design by using PS software can precisely recover the spinal sagittal balance and horizontal angle of view, so it can effectively avoid excessive correction and insufficient correction of the deformity and obtain good effectiveness in treating ASK.
介绍Photoshop CS16.0（PS）软件在强直性脊柱炎后凸畸形（ASK）术前截骨设计中的应用，并探讨术前设计的应用价值。
2009年3月至2013年3月，采用PS软件对21例ASK患者进行术前截骨设计。其中男性16例，女性5例，年龄23～50岁（平均34.2岁）。畸形类型包括胸腰段后凸14例，胸段后凸2例，腰段后凸5例。术前计划的最终截骨角度以及截骨的位置和范围由截骨设计确定，以指导外科医生的手术操作。实际截骨角度通过测量手术前后截骨节段的Cobb角获得。在术前、术后1周及末次随访时测量脊柱和骨盆的矢状面参数，包括全脊柱后凸（GK）、腰椎前凸（LL）、矢状垂直轴（SVA）、骨盆入射角（PI）、骨盆倾斜角（PT）和眉垂角（CBVA）。采用简化中文版脊柱侧弯研究学会-22（SRS-22）问卷和Oswestry功能障碍指数（ODI）评估临床疗效。
除1例术中硬脊膜撕裂和1例术后神经损伤外，其余病例均未发生并发症，切口均一期愈合。所有患者均获随访14～45个月（平均26.3个月）。术后1周及末次随访时SRS-22和ODI评分与术前相比均显著改善（P<0.05），但术后1周与末次随访之间差异无统计学意义（P>0.05）。术前计划截骨角度与术后实际截骨角度分别为（34.2±10.5）°和（33.7±9.7）°，差异无统计学意义（t=0.84，P=0.42）。与术前相比，CBVA、GK、SVA、PT和LL均显著改善（P<0.05），但术后1周与末次随访之间差异无统计学意义（P>0.05）。末次随访时，未发现内固定失败，均获得了骨性融合。
应用PS软件进行术前截骨设计能够精确恢复脊柱矢状面平衡和水平视野角度，有效避免畸形矫正过度和不足，治疗ASK疗效良好。
