Zhang Ning, Li Hao, Xu Zheng-Kuan, Chen Wei-Shan, Chen Qi-Xin, Li Fang-Cai
Department of Orthopaedics, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, PR China.
Indian J Orthop. 2017 Nov-Dec;51(6):666-671. doi: 10.4103/ortho.IJOrtho_222_16.
Advanced ankylosing spondylitis is often associated with thoracolumbar kyphosis, resulting in an abnormal spinopelvic balance and pelvic morphology. Different osteotomy techniques have been used to correct AS deformities, unfortunnaly, not all AS patients can gain spinal sagittal balance and good horizontal vision after osteotomy.
Fourteen consecutive AS patients with severe thoracolumbar kyphosis who were treated with two-level PSO were studied retrospectively. All were male with a mean age of 34.9 ± 9.6 years. The followup ranged from 1-5 years. Preoperative computer simulations using the Surgimap Spinal software were performed for all patients, and the osteotomy level and angle determined from the computer simulation were used surgically. Spinal sagittal parameters were measured preoperatively, after the computer simulation, and postoperatively and included thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence, pelvic tilt (PT), and sacral slope (SS). The level of correlation between the computer simulation and postoperative parameters was evaluated, and the differences between preoperative and postoperative parameters were compared. The visual analog scale (VAS) for back pain and clinical outcome was also assessed.
Six cases underwent PSO at L1 and L3, five cases at L2 and T12, and three cases at L3 and T12. TK was corrected from 57.8 ± 15.2° preoperatively to 45.3 ± 7.7° postoperatively ( < 0.05), LL from 9.3 ± 17.5° to -52.3 ± 3.9° ( < 0.001), SVA from 154.5 ± 36.7 to 37.8 ± 8.4 mm ( < 0.001), PT from 43.3 ± 6.1° to 18.0 ± 0.9° ( < 0.001), and SS from 0.8 ± 7.0° to 26.5 ± 10.6° ( < 0.001). The LL, VAS, and PT of the simulated two-level PSO were highly consistent with, or almost the same as, the postoperative parameters. The correlations between the computer simulations and postoperative parameters were significant. The VAS decreased significantly from 6.1 ± 1.9 to 2.0 ± 1.1 ( < 0.001). In terms of clinical outcome, 10 cases were graded "excellent" and 4 cases were graded "good."
Two-level PSO using a preoperative computer simulation is a feasible, safe, and effective technique for the treatment of severe thoracolumbar kyphosis in AS patients with normal cervical motion.
晚期强直性脊柱炎常伴有胸腰椎后凸，导致脊柱骨盆平衡和骨盆形态异常。已采用不同的截骨技术来矫正强直性脊柱炎畸形，不幸的是，并非所有强直性脊柱炎患者在截骨术后都能获得脊柱矢状面平衡和良好的水平视野。
回顾性研究14例连续接受两级全脊椎截骨术（PSO）治疗的重度胸腰椎后凸强直性脊柱炎患者。所有患者均为男性，平均年龄34.9±9.6岁。随访时间为1至5年。对所有患者术前使用Surgimap Spinal软件进行计算机模拟，并将计算机模拟确定的截骨水平和角度应用于手术中。术前、计算机模拟后及术后测量脊柱矢状面参数，包括胸椎后凸（TK）、腰椎前凸（LL）、矢状垂直轴（SVA）、骨盆入射角、骨盆倾斜度（PT）和骶骨倾斜度（SS）。评估计算机模拟与术后参数之间的相关性水平，并比较术前和术后参数之间的差异。还评估了背痛的视觉模拟量表（VAS）和临床结果。
6例患者在L1和L3行PSO，5例在L2和T12行PSO，3例在L3和T12行PSO。TK术前为57.8±15.2°，术后矫正至45.3±7.7°（P<0.05）；LL术前为9.3±17.5°，术后为-52.3±3.9°（P<0.001）；SVA术前为154.5±36.7，术后为37.8±8.4mm（P<0.001）；PT术前为43.3±6.1°，术后为18.0±0.9°（P<0.001）；SS术前为0.8±7.0°，术后为26.5±10.6°（P<0.001）。模拟的两级PSO的LL、VAS和PT与术后参数高度一致或几乎相同。计算机模拟与术后参数之间的相关性显著。VAS从6.1±1.9显著降低至2.0±1.1（P<0.001）。在临床结果方面，10例评为“优秀”，4例评为“良好”。
对于颈椎活动正常的强直性脊柱炎患者，术前计算机模拟下的两级PSO是治疗重度胸腰椎后凸的一种可行、安全且有效的技术。
