目的:本研究的目的是探讨影响强直性脊柱炎(AS)和胸腰椎后凸(TLK)患者术后生活质量的因素,并建立个性化矢状重建策略。
方法:回顾性纳入2009年2月至2019年5月接受椎弓根减影截骨术(PSO)的AS和TLK患者。手术前和最后一次随访时收集生活质量和脊柱矢状位影像学参数。根据Bath强直性脊柱炎功能指数和Oswestry残疾指数的最小临床重要差异(MCID),将患者分为两组。组间和组内进行影像学参数和临床结果的比较。回归分析用于确定缺失MCID队列中的危险因素。在达到的MCID队列中,使用骨盆发生率(PI)和胸廓入口角(TIA)建立矢状重建方程。
结果:该研究包括82名参与者。与术前测量相比,在最终随访期间观察到大多数影像学参数和所有生活质量指标的显着改善(p<0.05)。因素包括宫颈前凸(CL)≥18°(OR9.75,95%CI2.26-58.01,p=0.005),下巴-眉毛垂直角(CBVA)≥25°(OR14.7,95%CI3.29-91.21,p=0.001),骨盆倾斜(PT)≥33°(OR21.77,95%CI5.92-103.44,p<0.001)与未能达到MCID独立相关(p<0.05)。矢状面重新对准目标构建如下:骶骨斜率(SS)=0.84PI-17.4°(R2=0.81,p<0.001),胸椎后凸(TK)=0.51PI+10.8°(R2=0.46,p=0.002),颈部倾斜(NT)=0.52TIA-5.8°(R2=0.49,p<0.001),T1斜率(T1S)=0.48TIA+5.8°(R2=0.45,p=0.002)。
结论:PSO治疗AS并发TLK有效,产生有利的结果。CBVA≥25°,CL≥18°,PT≥33°是影响AS患者术后生活质量的主要因素。本研究的个性化矢状面重建策略主要针对AS患者的主观感觉和日常需求,由方程SS=0.84PI-17.4°描绘,TK=0.51PI+10.8°,NT=0.52TIA-5.8°,T1S=0.48TIA+5.8°。
OBJECTIVE: The aim of this study was to investigate the factors affecting postoperative quality of life in patients with ankylosing spondylitis (AS) and thoracolumbar kyphosis (TLK), and establish a personalized sagittal reconstruction strategy.
METHODS: Patients with AS and TLK who underwent pedicle subtraction osteotomy (PSO) from February 2009 to May 2019 were retrospectively included. Quality of life and spinal sagittal radiographic parameters were collected before surgery and at the last follow-up. Patients were divided into two groups based on the attainment of minimal clinically important difference (MCID) on the Bath Ankylosing Spondylitis Functional Index and Oswestry Disability Index. Comparisons of radiographic parameters and clinical outcomes were conducted between and within groups. Regression analysis was used to identify the risk factors within the missing MCID cohort. Sagittal reconstruction equations were established using the pelvic incidence (PI) and thoracic inlet angle (TIA) in the reached MCID cohort.
RESULTS: The study comprised 82 participants. Significant improvements were observed in most radiographic parameters and all quality-of-life indicators during the final follow-up compared with the preoperative measures (p < 0.05). Factors including cervical lordosis (CL) ≥ 18° (OR 9.75, 95% CI 2.26-58.01, p = 0.005), chin-brow vertical angle (CBVA) ≥ 25° (OR 14.7, 95% CI 3.29-91.21, p = 0.001), and pelvic tilt (PT) ≥ 33° (OR 21.77, 95% CI 5.92-103.44, p < 0.001) independently correlated with a failure to attain MCID (p < 0.05). Sagittal realignment targets were constructed as follows: sacral slope (SS) = 0.84 PI - 17.4° (R2 = 0.81, p < 0.001), thoracic kyphosis (TK) = 0.51 PI + 10.8° (R2 = 0.46, p = 0.002), neck tilt (NT) = 0.52 TIA - 5.8° (R2 = 0.49, p < 0.001), and T1 slope (T1S) = 0.48 TIA + 5.8° (R2 = 0.45, p = 0.002).
CONCLUSIONS: PSO proved efficacious in treating AS complicated by TLK, yielding favorable outcomes. CBVA ≥ 25°, CL ≥ 18°, and PT ≥ 33° were the primary factors affecting postoperative quality of life in patients with AS. The personalized sagittal reconstruction strategy in this study focused on the subjective sensations and daily needs of patients with AS, which were delineated by the equations SS = 0.84 PI - 17.4°, TK = 0.51 PI + 10.8°, NT = 0.52 TIA - 5.8°, and T1S = 0.48 TIA + 5.8°.