背景:强直性脊柱炎(AS)是一种自身免疫性脊椎关节炎,通常与刚性脊柱后凸相关。作者描述了一种手术方法,该方法采用多级三柱截骨术来恢复正常的整体对准。
方法:一名48岁有AS病史的男性,以弯腰姿势出现在诊所:他的下巴-眉毛垂直角(CBVA)为58.0°;T1斜率(T1S),97.8°;胸椎后凸(TK;T1-12);94.2°;近端TK(T1-5);50.8°;远端TK(T5-12),43.5°;和矢状垂直轴(SVA),22.6厘米。计划了两个阶段的程序。在第1阶段,将器械从C5放置到T10,然后进行T3脊柱切除。在第2阶段,将双侧椎弓根螺钉从T11放置到骨盆。完成L3椎弓根减骨术(PSO),然后进行T7PSO。术后,患者姿势明显改善:CBVA为29.3°;T1S,57.8°;TK,77.3°;近端TK,33.5°;远端TK,43.8°;和SVA,15厘米。术后6年,患者病情持续良好,没有构建体破裂的证据.
结论:作者提出多水平三柱截骨术,如果位置最佳,成功纠正与AS相关的脊柱排列不良。
BACKGROUND: Ankylosing spondylitis (AS) is an autoimmune spondylarthritis often associated with rigid kyphoscoliosis. The authors describe a surgical approach that employs multilevel three-column osteotomies for the restoration of normal global alignment.
METHODS: A 48-year-old male with a past medical history of AS presented to the clinic with a stooped-over posture: his chin-brow vertical angle (CBVA) was 58.0°; T1 slope (T1S), 97.8°; thoracic kyphosis (TK; T1-12), 94.2°; proximal TK (T1-5), 50.8°; distal TK (T5-12), 43.5°; and sagittal vertical axis (SVA), 22.6 cm. A two-stage procedure was planned. During stage 1, instrumentation was placed from C5 to T10, followed by a T3 vertebral column resection. During stage 2, bilateral pedicle screws were placed from T11 to the pelvis. An L3 pedicle subtraction osteotomy (PSO) was completed and was followed by a T7 PSO. Postoperatively, the patient had significant postural improvement: CBVA was 29.3°; T1S, 57.8°; TK, 77.3°; proximal TK, 33.5°; distal TK, 43.8°; and SVA, 15 cm. At 6 years postoperatively, the patient continued to do well and was without evidence of construct breakdown.
CONCLUSIONS: The authors propose that multilevel three-column osteotomies, if optimally located, successfully correct spinal malalignment associated with AS.