Short-term efficacy of pedicle subtraction osteotomy plus long segment fixation for kyphosis in ankylosing spondylitis combined with thoracolumbar fractures
10.3760/cma.j.issn.1001-8050.2019.06.004
- VernacularTitle:经椎弓根楔形截骨联合长节段椎弓根螺钉固定治疗强直性脊柱炎后凸畸形合并胸腰段骨折的短期疗效
- Author:
Changming LI
1
;
Shijie ZHAO
;
Jianzhu XU
;
Enliang CHEN
;
Qiang LI
;
Renfu QUAN
Author Information
1. 浙江中医药大学附属江南医院
- Keywords:
Spondylitis,ankylosing;
Spinal fractures;
Kyphosis;
Osteotomy
- From:
Chinese Journal of Trauma
2019;35(6):501-507
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the efficacy of pedicle subtraction osteotomy (PSO) plus long-segment pedicle nail bar system in treating kyphosis in ankylosing spondylitis (AS) combined with thoracolumbar fractures.Methods A retrospective case series study was made on the clinical data of 13 patients with kyphosis in AS combined with thoracolumbar fractures admitted to Xiaoshan Hospital of Traditional Chinese Medicine from January 2012 to May 2016.There were 11 males and two females,aged 32-64 years [(44.3 ± 10.6) years].Two fractures occurred at T11,five at T12,three at L1,and three at L2.According to the American Spinal Injury Association (ASIA) classification,the spinal injuries were rated as grade B in one patient,grade C in four,grade D in five and grade E in three.All patients underwent PSO plus long-segment pedicle nail bar system.The operation duration,intraoperative blood loss,fixation segments,and complications were recorded.Thoracolumbar kyphosis angle (TL) and sagittal vertical axis (SVA) were measured to evalute the correction effect.Visual analogue scale (VAS),Oswestry disability index (ODI),ASIA grade were compared before and after operation to assess the efficacy.Results All patients were followed up for 12-18 months [(15.2 ± 1.2) months].The operation time ranged from 120 to 256 minutes [(175.2 ±40.3)minutes].The intraoperative blood loss ranged from 660 to 3 300 ml [(1 011 ±681)ml].Number of fixed seqments was 12-16 (12.2 ±0.8).Anemia occurred in one patient after operation,and the patient recovered after blood transfusion.Incision infection occurred in one patient after operation,which was improved after antibiotic treatment through osmotic culture.Compared with the detection before operation,postoperative TL was improved significantly [(52.6 ± 6.2) ° vs.(17.1 ± 3.1) °],with an average correction rate of 67.5％;final follow-up showed decreased VAS [(7.5 ± 0.7) points vs.(1.9 ± 0.6) points] and decreased ODI [(75.2 ±5.3) points vs.(22.9 ± 4.4) points] (P ＜ 0.05);SVA was improved significantly [(11.5 ± 2.1) cm vs.(3.5 ± 0.9) cm],with an average correction rate of 69.6％ (P ＜ 0.05).ASIA grade was significantly improved at the final follow-up,including grade D in three patients and grade E in ten patients (P ＜0.05).There was no case of epidural hematoma or infection after operation,and no loosening of internal fixator or pseudarthrosis formation occurred during follow-up.Conclusion For kyphosis in AS combined with thoracolumbar fractures,PSO osteotomy plus long segment pedicle nail bar system treatment can significantly reduce lower back pain and promote functional recovery.
