目的:本研究旨在为强直性脊柱炎(AS)伴胸腰段后凸畸形(TLK)患者矫正手术中椎弓根减影截骨术(PSO)的根尖椎骨的确定方法。
方法:回顾性回顾了2009年5月至2022年8月接受PSO的TLKAS患者的病历,235名患者被纳入研究。使用所提出的方法,根据金氏顶点(KA)选择椎骨,定义为从T10椎体中心到S1上端板中点的直线的最远椎骨,作者分析了229例T12、L1或L2顶点的患者(由于样本量小,不包括L3,n=6)。他们将所有患者分为两组。A组(n=144)在KA椎骨接受PSO,而B组(n=85)接受不同水平的PSO。人口统计学和放射学数据,包括整个脊柱的矢状脊柱骨盆参数,被收集。对具有相同KA椎骨的患者进行了额外的分析。
结果:基于KA的患者的椎骨分布为T12(28[12.2%]),L1(119[52.0%]),和L2(82[35.8%])。矢状垂直轴校正(SVA;101.0±48.5mmvs82.0±53.8mm,p=0.010),整体后凸(GK;31.6°±10.0°vs26.4°±10.5°,p=0.005),和TLK(29.4°±10.2°vs24.2°±12.9°,p=0.012)A组明显大于B组,胸椎后凸(TK)的矫正没有差异,腰椎前凸,两组之间的盆腔发生率。进一步分析,A组TK校正较大(26.2°±13.7°vs0.1°±8.1°,对于以T12为KA的患者,p=0.013);SVA的改善更大(101.5±44.2mmvs73.4±48.7mm,p=0.020),GK(30.6°±11.0°vs25.0°±10.4°,p=0.046),和TLK(32.6°±7.8°vs26.7°±9.9°,p=0.012)对于以L1为KA的那些;TLK的显着校正(30.0°±6.3°vs4.3°±19.5°,p=0.008)对于L2为KA的患者,与B组相比,
结论:根尖椎骨的PSO可以更大程度地纠正矢状失衡。所提出的方法,根据KA选择椎骨,对于确定患有TLK的AS患者的顶点水平很容易重现。
OBJECTIVE: This study aimed to provide a method for determining the apical vertebra for pedicle subtraction osteotomy (PSO) in corrective surgery for patients with ankylosing spondylitis (AS) with thoracolumbar kyphosis (TLK).
METHODS: The medical records of AS patients with TLK who underwent PSO between May 2009 and August 2022 were retrospectively reviewed, and 235 patients were included in the study. Using the proposed method, choosing the vertebra based on Kim\'s
apex (KA), which is defined as the farthest vertebra from a line drawn from the center of the T10 vertebral body to the midpoint of the S1 upper endplate, the authors analyzed 229 patients with apices at T12, L1, or L2 (excluding L3 because of the small sample size, n = 6). They divided all patients into two groups. Group A (n = 144) underwent PSO at the KA vertebra, while group B (n = 85) underwent PSO at a different level. Demographic and radiological data, including sagittal spinopelvic parameters of the entire spine, were collected. An additional analysis was performed on patients with the same KA vertebra.
RESULTS: The vertebra distributions of patients based on KA were T12 (28 [12.2%]), L1 (119 [52.0%]), and L2 (82 [35.8%]). The corrections of sagittal vertical axis (SVA; 101.0 ± 48.5 mm vs 82.0 ± 53.8 mm, p = 0.010), global kyphosis (GK; 31.6° ± 10.0° vs 26.4° ± 10.5°, p = 0.005), and TLK (29.4° ± 10.2° vs 24.2° ± 12.9°, p = 0.012) in group A were significantly greater than those in group B, and there was no difference in the corrections of thoracic kyphosis (TK), lumbar lordosis, and pelvic incidence between the two groups. On further analysis, group A showed greater correction in TK (26.2° ± 13.7° vs 0.1° ± 8.1°, p = 0.013) for patients with T12 as the KA; greater improvements in SVA (101.5 ± 44.2 mm vs 73.4 ± 48.7 mm, p = 0.020), GK (30.6° ± 11.0° vs 25.0° ± 10.4°, p = 0.046), and TLK (32.6° ± 7.8° vs 26.7° ± 9.9°, p = 0.012) for those with L1 as the KA; and significant correction in TLK (30.0° ± 6.3° vs 4.3° ± 19.5°, p = 0.008) for patients with L2 as the KA, compared with group B.
CONCLUSIONS: PSO at the apical vertebra provides a greater degree of correction of sagittal imbalance. The proposed method, selecting the vertebra based on KA, is easily reproducible for determining the
apex level in AS patients with TLK.