使用「侷限性史密斯-彼德森截骨術」來矯正因僵直性脊椎炎所引起的堅硬性脊椎駝背

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Title:	使用「侷限性史密斯-彼德森截骨術」來矯正因僵直性脊椎炎所引起的堅硬性脊椎駝背
Other Titles:	Using ";Limited Smith-Petersen Osteotomy";to Correct Rigid Spinal Kyphosis in Ankylosing Spondylitis
Authors:	吳啟明 WU, CHI-MING
Contributors:	廖宏恩;徐尚為;藍守仁 LIAO, HUNG-EN;HSU, SHANG-WEI;LAN, SHOU-JEN 健康產業管理學系
Keywords:	侷限性史密斯-彼德森截骨術;嚴重胸腰椎後凸畸形;僵直性脊椎炎 limited Smith-Petersen osteotomy(LSPO);rigid thoracolumbar kyphotic deformities;ankylosing spondylitis
Date:	2023
Issue Date:	2023-11-22 01:21:09 (UTC+0)
Abstract:	前言: 本研究主要在探討採用侷限性史密斯-彼德森截骨術(Limited Smith-Petersen osteotomy)來矯正僵直性脊椎炎患者的嚴重胸腰椎後凸畸形的安全性、有效性和併發症。方法與材料: 自2016年1月1日至2020年12月31日，本研究共選取了18例（男15例，女3例）僵直性脊椎炎併發堅硬的脊柱後凸畸形之患者接受了侷限性史密斯-彼德森截骨術。研究比較了病人手術前及手術後的放射學參數，包括腰椎前凸角度、胸椎後凸角度、胸腰椎後凸角度、薦骨傾斜角度、骨盆傾斜角度、骨盆入射角度、整體脊柱後凸角度和疼痛視覺類比量表之分數，並同時分析手術時間、出血量及其它併發症的發生情況。結果: 所有患者的平均年齡為 42.2±13.4歲;平均手術時間為331.7±87.4分鐘;平均估計失血量為962.2±246.7毫升;平均追蹤時間為 29.6±21.3個月;術前腰椎前凸角度、薦骨傾斜角度和骨盆入射角度平均分別為 23.6°±18.2°、13.3°±15.5°和 48.1°±12.8°，術後增加到 41.2°±18.3°、25.8°±10.4°和 53.4°±13.8°;術前胸椎後凸角度、胸腰椎後凸角度、骨盆傾斜角度、整體脊柱後凸角度平均分別為50.9°±18.5°、30.2°±14.2°、39.6°±10.4°和37.5°±18.7°，術後分別下降至38.0°±19.5°、13.1°±8.0°、28.8°±9.1°和12.6°±8.7°。疼痛視覺類比量表評分由術前的8.8±0.88，術後顯著改善至1.5±0.62。因為上述各項參數的P<0.05，故其差異有顯著的統計學意義。而手術病人中有一位患者出現椎弓根螺釘鬆動和神經根壓迫，故本研究安排了另一次脊柱翻修手術，成功解決了他的背痛和神經症狀。有兩名患者出現硬腦膜撕裂，於手術中當下立即實施硬腦膜縫補修復並臥床休息後於兩週內康復。有一名患者有表淺性傷口感染，使用抗生素治療後痊癒。沒有發現致命死亡、大血管損傷、肺炎和深部傷口感染。所有患者在追蹤訪查12個月後均獲得良好且牢固的骨頭融合。結論: 侷限性史密斯-彼德森截骨術是治療僵直性脊椎炎併發嚴重脊椎後凸畸形患者獲得滿意的截骨矯正角度的一種安全且有效的手術方法。 Introduction:The aim of this study was to investigate the safety, effectiveness , and complications of a method of limited Smith-Petersen osteotomy(LSPO) was used to correct rigid thoracolumbar kyphotic deformities in patients with ankylosing spondylitis (AS).Materials and Methods:From January 01, 2016 to December 31, 2020, a total of 18 patients (15 males and 3 females) with ankylosing spondylitis and rigid spinal kyphosis in our study underwent the operation of limited Smith-Petersen osteotomy. The radiological parameters, including lumbar lordosis(LL), thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), sacral slope(SS), pelvic tilt(PT), pelvic incidence(PI), global kyphosis(GK), and the visual analogue scale(VAS) were compared from preoperative and postoperative radiograms. The operative time, blood loss and other complications were also analyzed.Results: The mean age of patients was 42.2�13.4 years. The average operative time was 331.7�87.4 minutes. The mean estimated blood loss was 962.2�246.7 ml. The mean follow-up was 29.6�21.3 months. The mean preoperative LL, SS, and PI were 23.6��18.2�, 13.3��15.5�, and 48.1��12.8�, respectively, and increased to 41.2��18.3�, 25.8��10.4�, and 53.4��13.8� postoperatively. The mean preoperative TK, TLK, PT, and GK were 50.9��18.5�, 30.2��14.2�, 39.6��10.4�, and 37.5��18.7�, respectively, and decreased to 38.0��19.5�, 13.1��8.0�, 28.8��9.1�, and 12.6��8.7�postoperatively. The VAS scores were improved significantly from 8.8�0.88 before surgery to 1.5�0.62 after surgery. All above parameters had statistically significant difference because of P< 0.05. There was one patient suffered from pedicle screws loosening and nerve root compression. We arranged another revision spinal surgery to resolve his back pain and nervous symptoms successfully. Two patients had small dura tears and recovered after dura repairment immediately and bed rest . One patient had superficial wound infection and healed after antibiotics use. No fatal mortality, major vessel injury, pneumonia and deep wound infection were noted. All patients had good solid bone fusion after 12 months of follow-up. Conclusion: Limited Smith-Petersen osteotomy(LSPO) was a kind of safe and effective surgical method to obtain satisfactory kyphosis correction in ankylosing spondylitis patient with rigid spinal kyphosis.
Appears in Collections:	[健康產業管理學系] 博碩士論文

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