中国组织工程研究

中国组织工程研究 ›› 2015, Vol. 19 ›› Issue (13): 2069-2074.doi: 10.3969/j.issn.2095-4344.2015.13.019

• 脊柱植入物 spinal implant • 上一篇    下一篇

螺钉置入修复强直性脊柱炎并发重度车轮状后凸畸形：应力分布于多节段

马俊毅，杨  静，马  原，田慧中   

  1. 新疆医科大学第六附属医院脊柱外一科，新疆维吾尔自治区乌鲁木齐市  830000
  • 收稿日期:2015-01-14 出版日期:2015-03-26 发布日期:2015-03-26
  • 通讯作者: 马原，硕士，主任医师，教授，博士生导师，新疆医科大学第六附属医院脊柱外一科，新疆维吾尔自治区乌鲁木齐市 830000
  • 作者简介:马俊毅，男，1986年生，新疆吾维尔自治区人, 东乡族，新疆医科大学在读硕士，主要从事脊柱临床研究。
  • 基金资助:

    国家自然科学基金资助项目(81360280)，项目名称：强直性脊柱炎后凸后路VCR/VCD矫形有限元模拟研究

Screw placement in repair of ankylosing spondylitis complicated by severe wheel-like kyphosis: stress distribution in multiple segments

Ma Jun-yi, Yang Jing, Ma Yuan, Tian Hui-zhong   

  1. First Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Received:2015-01-14 Online:2015-03-26 Published:2015-03-26
  • Contact: Ma Yuan, Master, Chief physician, Professor, Doctoral supervisor, First Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • About author:Ma Jun-yi, Studying for master’s degree, First Department of Spine Surgery, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
  • Supported by:

    the National Natural Science Foundation of China, No. 81360280

PDF

463

摘要：

背景：强直性脊柱炎并发后凸畸形是病变后期出现的脊柱矢状面上的车轮状畸形，重度车轮状后凸畸形患者，行脊柱截骨矫形是惟一的治疗方法。对于强直性脊柱炎并发同时存在于胸段、胸腰段以及腰段重度车轮状后凸畸形的患者，单一部位截骨很难获得安全有效的矫形效果。
目的：观察全脊柱截骨联合V形截骨螺钉置入内固定对强直性脊柱炎并发重度车轮状后凸畸形的矫正效果，并分析应力分布情况。
方法：2003年5月至2012年10月新疆医科大学第六附属医院采用全脊柱截骨联合V形截骨、椎弓根螺钉置入内固定修复强直性脊柱炎并发同时存在重度胸段、胸腰段以及腰段后凸的车轮状畸形患者36例，均为男性。测量脊柱后凸角、颌眉角、C7铅垂线以评价矫正效果。
结果与结论：治疗后1周全脊柱最大后凸Cobb角由治疗前的(89.6±9.8)°矫正到(32.2±6.7)°，与治疗前差异有显著性意义(P < 0.05)，平均矫正率64%；颌眉角平均矫正到9.6°(P < 0.05)，平均矫正率76%；C7铅垂线平均矫正到4.4 cm(P < 0.05)，平均矫正率81%。随访24-48个月，末次随访时上述指标与术后1周比较差异无显著性意义(P > 0.05)，X射线片显示所有患者内固定位置良好。提示对于强直性脊柱炎引起的重度车轮状后凸畸形患者，行全脊柱截骨联合V形截骨螺钉置入内固定治疗是一种安全、有效的方法，可较好地矫正脊柱矢状面曲度还能降低矢状面成角过度的风险，使应力分布于多节段，使脊髓短缩及硬膜皱折分布于相对较长的节段，避免在短节段内脊髓短缩和硬膜皱折过度而引起神经损伤。


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


全文链接：

关键词: 植入物, 脊柱植入物, 强直性脊柱炎, 后凸畸形, 全脊柱截骨, V形截骨, 螺钉置入, 国家自然科学基金

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 in patients with severe wheel-like kyphosis. For thoracic and thoracolumbar ankylosing spondylitis patients with lumbar severe wheel-like kyphosis, osteotomy at a single site cannot obtain safe and effective orthopedic effect.
OBJECTIVE: To observe the orthopedic effect of total spine osteotomy combined with V-shaped osteotomy for correction of severe wheel-like kyphosis deformity due to ankylosing spondylitis, and to analyze stress  distribution.
METHODS: From May 2003 to October 2012, total spine osteotomy combined with V-shaped osteotomy and pedicle screw fixation were adopted for repair of concurrent thoracic, thoracolumbar and lumbar severe wheel-like kyphosis deformity due to ankylosing spondylitis in 36 male cases in the Sixth Affiliated Hospital of Xinjiang Medical University. Spinal convex angle, chin-brow vertical angle and C7 plumb line were measured to evaluate orthopedic effect.
RESULTS AND CONCLUSION: The whole spine convex Cobb angle was corrected from preoperatively (89.6±9.8)° to (32.2±6.7)° at 1 week after treatment, showing significant difference (P < 0.05), with an average correction rate of 64%. The chin-brow vertical angle was 9.6° averagely after correction (P < 0.05), with an average correction rate of 76%. The C7 plumb line was 4.4 cm averagely after correction (P < 0.05), with an average correction rate of 81%. After follow-up of 24-48 months, no significant difference in above indexes was detected during final follow-up and 1 week postoperatively (P > 0.05). Radiographs demonstrated that fixation position was good in all patients. These results confirmed that in patient with severe wheel-like kyphosis deformity due to ankylosing spondylitis, the application of total spine osteotomy combined with V-shaped osteotomy is a safe and effective method, can better correct the spinal sagittal curvature and reduce the risk of sagittal angle, result in the stress distribution in many segments and the shortening of the spine and epidural buckling in relatively long segment, can avoid nerve damage induced by spinal cord shortening and epidural excessive buckling within short segment.


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


全文链接：

Key words: Spondylitis, Ankylosing, Kyphosis, Osteotomy, Bone Nails, Internal Fixators

中图分类号: