Liang Yan, Tang Xiangyu, Zhao Yongfei, Wang Zheng
Orthopedic Department, The General Hospital of Chinese People's Liberation Army (301 hospital) Beijing, No.28.Fu Xing Rd, Hai Dian District, 100853, Beijing, China.
J Orthop Surg Res. 2017 Mar 31;12(1):54. doi: 10.1186/s13018-017-0556-5.
Andersson lesion is a well-known complication in ankylosing spondylitis. Recently, owing to the worry about the healing of fracture, some scholars advocated additional anterior surgery or other procedures were necessary, which increase the risk of the nerve injury. The purpose of this study is to introduce our experience and to explore the efficacy and feasibility of posterior wedge osteotomy and debridement through Andersson Lesion for surgical treatment of severe kyphosis in ankylosing spondylitis.
From January 2012 to January 2014, a retrospective study of 14 Andersson lesion patients with severe kyphosis in ankylosing spondylitis treated with surgery was completed with an at least 2-year follow-up. The debridement procedure, before posterior wedge osteotomy in posterior approach, must scrape all sclerosis bone until healthy cancellous bone appears. Radiographic and clinical results and complications were assessed with an average follow-up of 24 months. The CT scan was obtained preoperatively and at the final follow-up to assess the displacement of the fracture preoperatively, the safety of screw insertion, the healing of the fracture at the final follow-up. The Bridwell interbody fusion grading system was used to assess the healing of the fracture.
Local kyphosis was substantially corrected from 51.7 ± 15.6 to 7.1 ± 19.5, with a mean correction of 44°. The global kyphosis (GK) changed from 60.6 ± 28.3 to 20.3 ± 10.3 (P = 0.000). The mean VAS back pain scores decreased from 6.7 ± 0.8 preoperatively to 0.75 ± 0.6 after a 2-year follow-up (P = 0.000). The ODI score improved from 60.56 ± 15.1% preoperatively to 23.46 ± 8.2% after a 2-year follow-up (P = 0.000). The CT scan showed solid fusion at the level of the AL, and no internal fixation loose. All patients achieved grade 1 fusion. No major complication occurred.
The posterior wedge osteotomy and debridement through AL can be used to correct the severe kyphosis in ankylosing spondylitis, achieving favorable clinical outcomes, good fusion, and satisfactory deformity correction.
安德森病变是强直性脊柱炎中一种广为人知的并发症。近来，由于担心骨折愈合问题，一些学者主张有必要进行额外的前路手术或其他操作，这增加了神经损伤的风险。本研究的目的是介绍我们的经验，并探讨通过安德森病变进行后路楔形截骨术和清创术治疗强直性脊柱炎严重后凸畸形的疗效和可行性。
2012年1月至2014年1月，对14例接受手术治疗的强直性脊柱炎安德森病变严重后凸畸形患者进行回顾性研究，随访至少2年。在后路手术进行后路楔形截骨术前的清创过程中，必须刮除所有硬化骨，直至出现健康的松质骨。平均随访24个月，评估影像学和临床结果及并发症。术前及末次随访时行CT扫描，以评估术前骨折移位情况、螺钉置入安全性及末次随访时骨折愈合情况。采用布里德韦尔椎间融合分级系统评估骨折愈合情况。
局部后凸畸形从51.7±15.6显著矫正至7.1±19.5，平均矫正44°。整体后凸畸形（GK）从60.6±28.3变为20.3±10.3（P = 0.000）。平均视觉模拟评分法（VAS）背痛评分从术前的6.7±0.8降至2年随访后的0.75±0.6（P = 0.000）。脊柱功能障碍指数（ODI）评分从术前的60.56±15.1%提高至2年随访后的23.46±8.2%（P = 0.000）。CT扫描显示安德森病变（AL）水平融合牢固，无内固定松动。所有患者均达到1级融合。未发生重大并发症。
通过AL进行后路楔形截骨术和清创术可用于矫正强直性脊柱炎的严重后凸畸形，取得良好的临床效果、良好的融合及满意的畸形矫正效果。
