强直性脊柱炎应力骨折后路经骨折线闭合截骨
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中南大学湘雅医院

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国家自然科学基金项目(面上项目,重点项目,重大项目)


Posterior closed osteotomy through fracture line for ankylosing spondylitis with stress fracture
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Xiangya Hospital, Central South University

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National Natural Science Foundation of China

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    摘要:

    [目的]介绍强直性脊柱炎应力骨折后路经骨折线闭合截骨的手术技术和初步临床结果。[方法]2010年1月至2021年6月,对16例患者行此手术。做后路正中切口。在椎弓根两侧分别置入螺钉。沿脊柱两侧骨折缝骨膜下剥离。显露硬膜囊及神经根。安装临时固定棒,清除骨折缝各类组织;若需矫正后凸畸形,经骨折缝行“V”字形修整;同法操作对侧。植入骨粒或钛笼。安装固定棒,逐步闭合截骨线,矫形满意后锁紧螺帽。[结果]平均随访25.1月;末次随访胸椎后凸角(TK)、脊柱后凸角(GK)、固定节段角度(AFL)、局部后凸角(LK)、矢状面躯干偏移(SVA)、疼痛视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)均较术前明显改善(P<0.05)。所有患者骨折端均骨性融合。8例患者术前不能平视行走,术后恢复。1例术后双下肢肌力下降,经康复治疗后恢复。[结论]后路经骨折线闭合截骨能彻底清除骨折断端坏死组织,明显缓解疼痛,并矫正畸形,利于骨折愈合,是一种安全且有效的术式。

    Abstract:

    [Objective] To introduce the surgical technique and preliminary clinical results of posterior closed osteotomy through fracture line in ankylosing spondylitis with stress fracture. [Methods] From January 2010 to June 2021, 16 patients underwent this operation. Make a posterior midline incision. Screws were placed on either side of the pedicle. Subperiosteal dissection along bilateral spinal fractures. Exposure of the dural sac and nerve roots. Install temporary fixed rod, remove all kinds of tissue of fracture seam; If corrective kyphosis is needed, "V" shape repair is performed through fracture suture. Do the same on the opposite side. Implant bone pellets or titanium cage. Install the fixed rod, gradually close the osteotomy line, and lock the nut when the orthosis is satisfied. [Results] The mean follow-up was 25.1 months. At the last follow-up, thoracic kyphosis (TK), global kyphosis (GK), angle of the fusion levels (AFL), local kyphosis (LK), sagittal vertical axis (SVA), visual analog scale (VAS) and Oswestry disability index (ODI) were significantly improved compared with preoperative results(P<0.05). All the patients had bone fusion at the fracture end. 8 patients could not walk with eye level before surgery, and 1 patient recovered with decreased muscle strength of lower limbs after surgery and recovered after rehabilitation treatment.[Conclusion] The posterior closed osteotomy through the fracture line can completely remove the necrotic tissue of the fracture end, relieve the pain obviously, and correct the deformity at the same time, which is beneficial to fracture healing, so it is a safe and effective operation.

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  • 收稿日期:2021-11-12
  • 最后修改日期:2022-01-20
  • 录用日期:2022-04-14
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