Clinical efficacy of preoperative osteotomy designs using paper-cut technology versus photoshop software for ankylosing spondylitis with kyphosis

doi:10.3969/j.issn.2095-4344.2017.07.014

Abstract

Abstract:

BACKGROUND: There are various kinds of design methods about preoperative osteotomy of ankylosing spondylitis with kyphosis, but each has their own errors and limitations. A convenient, precise and available method needs to be developed.

OBJECTIVE: To compare the clinical efficacy of two different preoperative osteotomy designs using paper-cut and photoshop software for ankylosing spondylitis with kyphosis.

METHODS: Thirty-nine patients suffering ankylosing spondylitis with kyphosis undergoing osteotomy in the Department of Spinal Surgery, Affiliated Hospital of Yan’an University between June 2009 and January 2015 were enrolled, and randomly allotted to paper-cut (n=19) and photoshop (n=20) groups, followed by the preoperative osteotomy design, respectively. All patients were followed for 12-40 months to compare the postoperative osteotomy angle error and correction efficacy at the last follow-up between groups.

RESULTS AND CONCLUSION: (1) The postoperative osteotomy angle error in the photoshop group was significantly smaller than that in the paper-cut group (P < 0.05). (2) At the last follow-up, the key parameters of sagittal spine and pelvis (sagittal vertical axis, Cobb angle and pelvic tilt) showed significant differences between groups (P < 0.05). (3) The Oswestry disability index and Scoliosis Research Society-22 questionnaire scores in the photoshop group were significantly superior to those in the paper-cut group at the last follow-up (P < 0.05), while the visual analog scale scores did not differ significantly between groups (P > 0.05). (4) To conclude, compared with the osteotomy design using traditional paper-cut splice, the photoshop software can achieve a smaller osteotomy angle error and better postoperative balance of spinal sagittal plane, thus providing precise osteotomy for surgeons to obtain proper correction.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Spondylitis, Ankylosing, Kyphosis, Osteotomy, Tissue Engineering

CLC Number:

R318

Wang Fei, Liu Zhi-bin, Tao Hui-ren, Zhang Jian-hua, Li Chang-hong, Cao Qiang, Zheng Jun, Liu Yan-xiong, Qu Xiao-peng. Clinical efficacy of preoperative osteotomy designs using paper-cut technology versus photoshop software for ankylosing spondylitis with kyphosis[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(7): 1057-1063.

Figures/Tables 3

2.1 参与者数量分析纳入41例强直性脊柱炎合并后凸畸形患者，其中1例失去随访，1例患者死于其他疾病，其余39例随机分组，剪纸拼接组19例，PS组20例。2组分组流程图见图3。 2.2 一般资料 PS组20例患者中，均为单个椎体截骨(L3 12例，L4 4例，L2 4例)；14例截骨角度选择为PS软件模拟计算的截骨角度，6例截骨角度根据患者的颌眉角度及个人生活习惯进行了修正。剪纸拼接组19例患者中均为单个椎体截骨(L1 2例，L2 5例，L3 9例，L4 3例)，截骨角度由拓印的纸片进行裁剪拼接和术者经验结合所确定。将2组中的年龄、性别及代表术前脊柱后凸畸形程度的矢状位垂直轴与全脊柱后凸角度参数进行统计学对比(表1)，结果表明2组以上指标差异均无显著性意义(P > 0.05)，确定2组数据术后结果有可对比性。 2.3 影像学测量及临床功能评分结果如表1所示，2组术前的脊柱骨盆的关键矢状面参数(矢状位垂直轴、全脊柱后凸角、骨盆倾斜角)以及颌眉角与术后1周、末次随访时对比，差异均有显著性意义(P < 0.01)，而术后1周和末次随访相比差异无显著性意义(P > 0.05)，表明2组患者均获得了一定的矫形效果。对比2组末次随访时脊柱骨盆关键矢状位参数(矢状位垂直轴、全脊柱后凸角、骨盆倾斜角)差异均有显著性意义(P < 0.05)，表明PS组术后的矢状位垂直轴、全脊柱后凸角以及骨盆倾斜角值更接近理想脊柱骨盆矢状面参数(骨盆倾斜角<20°、矢状位垂直轴<5 cm)[26]。 2组术前的目测类比评分、ODI以及SRS-22量表总分与术后1周、末次随访时对比，差异均有显著性意义(P < 0.01)，而术后1周和末次随访相比差异无显著性意义(P > 0.05)，表明2组患者术后功能均有明显改善；而PS组末次随访的ODI 和SRS-22评分要显著优于剪纸拼接组，差异有显著性意义(P < 0.05) ，末次随访时2组目测类比评分差异无显著性意义(P > 0.05)。 PS组所有病例的术前计划截骨角度与术后实际的截骨角度非常接近，2组数据差异无显著性意义；而剪纸拼接组术前计划截骨角度与术后实际的截骨角度差异有显著性意义(P > 0.05)。对比2组的截骨角度误差(术前计划截骨角度和术后实际截骨角度差值的绝对值)，数据结果显示PS组的截骨角度误差显著小于剪纸拼接组(P < 0.05，表2)。 2.4 典型病例男性强直性脊柱炎后凸畸形患者，35岁，术前应用PS软件进行截骨模拟设计，见图4。 2.5 不良事件 PS组术后1例患者出现脑脊液露，术中予以缝合修补，术后出现脑脊液漏，术后予以头低较高位，术后1周拔除引流管；2组各出现1例术后下肢肌力下降和部分皮肤感觉减退，予以营养神经药物及高压氧治疗后逐渐缓解。"

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