中国组织工程研究

中国组织工程研究 ›› 2012, Vol. 16 ›› Issue (17): 3218-3222.doi: 10.3969/j.issn.1673-8225.2012.17.040

• 骨与关节综述 bone and joint review • 上一篇    下一篇

强直性脊柱炎后凸畸形矫形修复中截骨方法的进展☆

宋若先，张永刚   

  1. 解放军总医院骨科，北京市 100853
  • 收稿日期:2012-01-21 修回日期:2012-02-22 出版日期:2012-04-22 发布日期:2012-04-22
  • 作者简介:宋若先☆，男，1971年生，汉族，山东省安丘市人，解放军总医院在读博士，副主任医师，主要从事脊柱疾病的基础与临床研究。

Research progress of osteotomies for correction of kyphotic deformity in ankylosing spondylitis

Song Ruo-xian, Zhang Yong-gang   

  1. Department of Orthopedics, General Hospital of Chinese PLA, Beijing  100853, China
  • Received:2012-01-21 Revised:2012-02-22 Online:2012-04-22 Published:2012-04-22
  • About author:Song Ruo-xian☆, Studying for doctorate, Associate chief physician, Department of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, China

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摘要：

背景：强直性脊柱炎后凸畸形是病变后期出现的脊柱矢状面上的屈曲畸形，脊柱截骨矫形是唯一的治疗方法。
目的：综述国内外关于强直性脊柱炎后凸畸形的截骨矫形方法及其应用现状。
方法：计算机检索中国生物医学文献数据库、中文科技期刊全文数据库、中文学术期刊全文数据库及PubMed、EMbase数据库2000-01/2011-12期间的相关文章，检索词为“强直性脊柱炎，脊柱后凸，截骨；ankylosing spondylitis；kyphosis；osteotomy”。此外还查阅相关文献中引用的原始文献数篇。纳入强直性脊柱炎后凸畸形的截骨方法、适应证和效果的论著类文章。
结果与结论：按照截骨矫形后的三柱变化，临床常用的截骨方法主要有：开张型、闭合型和闭合-开张型截骨。目前强直性脊柱炎后凸畸形的截骨矫形术式主要有:后路多节段经椎间关节V形截骨、经椎弓根椎体截骨、脊椎切除以及脊柱去松质骨截骨。前二者是目前临床上治疗强直性脊柱炎后凸畸形应用最多的两种标准化矫形技术，而后二者则主要应用于后凸顶点较局限或顶椎区楔形变的重度角状后凸畸形。且不同截骨方法各有其相应技术要点、适应证及并发症，选择恰当的截骨方法有助于后凸畸形的有效矫正。
 

关键词: 强直性脊柱炎, 脊柱后凸, 截骨, 后路多节段经椎间关节V形截骨, 椎弓根椎体截骨, 脊椎切除, 脊柱去松质骨截骨

Abstract:

BACKGROUND: Kyphotic deformity in ankylosing spondylitis is the flexion deformity of spine sagittal plane in the late lesion; spinal osteotomy is the only treatment method.
OBJECTIVE: To review the methods and application of osteotomy on the correction of kyphotic deformity in ankylosing spondylitis.
METHODS: The Chinese Biomedical Literature database, CNKI database, China Academic Journals Full-text database, PubMed database and EMbase database were retrieved for articles published from January 2000 to December 2011 with keywords of “ankylosing spondylitis; kyphosis; osteotomy” in Chinese and English. Papers concerning methods, indications and effects of osteotomy on correction of kyphotic deformity in ankylosing spondylitis were included．
RESULTS AND CONCLUSION: The types of posterior spinal osteotomies include: opening wedge osteotomy, closing wedge osteotomy and closing-opening wedge osteotomy, which have been described and widely used. Polysegmental Smith-Petersen osteotomy, pedicle subtraction osteotomy, vertebral column resections and vertebral column decancellations are the most four methods of osteotomy for the correction of kyphotic deformity. The polysegmental Smith-Petersen osteotomy and pedicle subtraction osteotomy are most widely used two standardized orthopedic technology for the treatment of kyphotic deformity in ankylosing spondylitis, and the vertebral column resections and vertebral column decancellations are mainly used for the treatment of severe angular kyphosis with vertex limitations or wedging of the apical region. Different osteotomies have their own indications, operative technique and complications, so the appropriate osteotomy can help to correct the kyphotic deformity effectively.
 

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