Shenzhen University Health Science Center, Shenzhen, Guangdong, 518000, People's Republic of China.
Department of Orthopedics, Shenzhen University General Hospital, Shenzhen, Guangdong, 518000, People's Republic of China.
BMC Musculoskelet Disord. 2022 Aug 18;23(1):790. doi: 10.1186/s12891-022-05740-9.
This study aimed to determine preoperative predictors for sagittal imbalance in kyphosis secondary to ankylosing spondylitis (AS) after one-level three-column osteotomy.
A total of 55 patients with AS who underwent one-level three-column osteotomy were enrolled. The patients were divided into two groups according to sagittal vertical axis (SVA) value at the final follow-up (group A: SVA > 5 cm; group B: SVA ≤ 5 cm). The radiographic measures included global kyphosis, lumbar lordosis (LL), pelvic tilt (PT), pelvic incidence (PI), sacral slope, T1 pelvic angle (TPA), SVA, osteotomized vertebral angle and PI and LL mismatch (PI - LL). Postoperative clinical outcomes were evaluated using Scoliosis Research Society-22 questionnaire (SRS-22) and Oswestry Disability Index (ODI).
Fifty-five AS patients had an average follow-up of 30.6 ± 10.2 months (range 24-84 months). Group A had larger preoperative and postoperative LL, PT, PI - LL, TPA and SVA values compared with group B (P < 0.05), and no significant differences were found in ODI and SRS-22 scores between the two groups (P > 0.05). Preoperative LL, PT, PI - LL, TPA, and SVA values were positively correlated with the follow-up SVA value (P < 0.05). Among them, TPA > 40.9°, PI - LL > 32.5° and SVA > 13.7 cm were the top three predictors with the best accuracy to predict sagittal imbalance. Immediate postoperative SVA value of ≤ 7.4 cm was a key factor in reducing the risk of sagittal imbalance during follow-up.
Preoperative TPA > 40.9°, PI - LL > 32.5° and SVA > 13.7 cm could predict sagittal imbalance in AS kyphosis after one-level three-column osteotomy, and additional osteotomies were recommended for this condition. Immediate postoperative SVA ≤ 7.4 cm was an optimal indicator for preventing sagittal imbalance.
IV.
本研究旨在确定强直性脊柱炎（AS）后单节段三柱截骨术后矢状位失衡的术前预测因素。
共纳入 55 例接受单节段三柱截骨术的 AS 患者。根据最终随访时的矢状垂直轴（SVA）值将患者分为两组（组 A：SVA＞5cm；组 B：SVA≤5cm）。影像学测量指标包括整体后凸角、腰椎前凸角（LL）、骨盆倾斜角（PT）、骨盆入射角（PI）、骶骨倾斜角、T1 骨盆角（TPA）、SVA、截骨椎体角度和 PI-LL 不匹配。术后临床结果采用脊柱侧凸研究协会 22 项问卷（SRS-22）和 Oswestry 功能障碍指数（ODI）进行评估。
55 例 AS 患者平均随访 30.6±10.2 个月（24-84 个月）。与组 B 相比，组 A 的术前和术后 LL、PT、PI-LL、TPA 和 SVA 值更大（P＜0.05），两组的 ODI 和 SRS-22 评分无显著差异（P＞0.05）。术前 LL、PT、PI-LL、TPA 和 SVA 值与随访 SVA 值呈正相关（P＜0.05）。其中，TPA＞40.9°、PI-LL＞32.5°和 SVA＞13.7cm 是预测矢状位失衡的三个最佳预测指标，准确性最高。术后即刻 SVA 值≤7.4cm 是减少随访时矢状位失衡风险的关键因素。
术前 TPA＞40.9°、PI-LL＞32.5°和 SVA＞13.7cm 可预测 AS 后单节段三柱截骨术后的矢状位失衡，对此类患者建议进行额外的截骨术。术后即刻 SVA 值≤7.4cm 是预防矢状位失衡的最佳指标。
IV。
