Department of Orthopaedics, Fuyang People's Hospital Affiliated to Anhui Medical University, Anhui, 236000, China.
Clinical Research Center for Spinal Deformity of Anhui Province, Anhui, 236000, China.
BMC Musculoskelet Disord. 2023 Sep 11;24(1):723. doi: 10.1186/s12891-023-06810-2.
Cervical stiffness, coronal imbalance and limited hip movement all play crucial roles in designing the corrective surgery for ankylosing spondylitis-related thoracolumbar kyphosis (AS-TLK). However, a comprehensive classification and tailored strategies for directing clinical work are lacking. This study aims to investigate the types and surgical strategies for AS-TLK that consider cervical stiffness, coronal imbalance and hip involvement as the key factors.
25 consecutive AS-TLK patients were divided into three types according to their accompanying features: Type I: with a flexible cervical spine; Type IIA: with a stiff cervical spine; Type IIB: with coronal imbalance; Type IIC: with limited hip movement. Type III is the mixed type with at least two conditions of Type II. Individual strategies were given correspondingly. Spinal-pelvic-femoral parameters were measured, Scoliosis Research Society outcome instrument-22 (SRS-22) was used and complications were recorded and analysed.
All patients (Type I 10, Type II 8 and Type III 7) underwent surgery successfully. 13 cases with 16 complications were recorded and cured. The patients were followed up for 24-65 months with an average of 33.0 ± 9.6 months. Both the sagittal and coronal parameters were corrected and decreased significantly (all, p < 0.05). SRS-22 scores showed a satisfactory outcome.
Thoracolumbar kyphosis secondary to ankylosing spondylitis are complex and variable. Considering the factors of cervical stiffness, coronal imbalance and hip involvement assists in making decisions individually and achieving a desired surgical result.
颈椎僵硬、冠状面失衡和髋关节活动受限在强直性脊柱炎相关胸腰椎后凸畸形（AS-TLK）的矫形手术设计中都起着至关重要的作用。然而，缺乏全面的分类和有针对性的策略来指导临床工作。本研究旨在探讨考虑颈椎僵硬、冠状面失衡和髋关节受累作为关键因素的 AS-TLK 类型和手术策略。
根据伴随特征将 25 例连续 AS-TLK 患者分为 3 型：I 型：颈椎柔韧性好；IIA 型：颈椎僵硬；IIB 型：冠状面失衡；IIC 型：髋关节活动受限。III 型是至少有两种 II 型情况的混合型。相应地给予个体化策略。测量脊柱骨盆股骨参数，使用脊柱侧凸研究协会 22 项结果量表（SRS-22），并记录和分析并发症。
所有患者（I 型 10 例，II 型 8 例，III 型 7 例）均成功手术。记录到 13 例 16 处并发症并治愈。患者平均随访 24-65 个月，平均 33.0±9.6 个月。矢状面和冠状面参数均得到明显矫正和降低（均 p<0.05）。SRS-22 评分显示出满意的结果。
强直性脊柱炎引起的胸腰椎后凸畸形复杂多变。考虑颈椎僵硬、冠状面失衡和髋关节受累等因素有助于个体化决策，并达到理想的手术效果。
