目的 探讨经椎弓根椎体截骨术（PSO）联合卫星棒技术治疗强直性脊柱炎（AS）胸腰椎后凸畸形的临床疗效。 方法 回顾性队列研究。纳入2016年9月—2021年6月南京大学医学院附属鼓楼医院29例AS胸腰椎后凸畸形患者，其中男26例、女3例，年龄18~55（35.5±9.9）岁。本组患者均采用单节段PSO联合卫星棒技术治疗。根据围截骨区单侧或双侧使用卫星棒固定，将患者分为2组：单侧组13例，双侧组16例。观察指标：（1）基于患者站立位全脊柱X线侧位片测量和观察患者的矫正效果，比较2组术前、术后即刻及末次随访时矢状面平衡（SVA）、腰椎前凸角（LL）、全脊柱后凸角（GK），以及术后即刻与末次随访时的截骨角（OVA）、融合节段角（AFS）。（2）比较患者并发症发生率，重点观察力学并发症断棒的发生情况。 结果 2组患者的年龄、性别、随访时间、截骨水平等基线资料比较，差异均无统计学意义（P值均>0.05）。29例患者手术均顺利，术后均获得随访，随访时间12~72（26.4±10.7）个月。（1）组内比较：单侧组术前SVA、GK、LL分别为（162.1±53.3）mm、79.7°±16.8°、-9.5°±20.4°，术后即刻分别为（64.1±42.5）mm、34.4°±20°、-44.0°±10.8°，末次随访时分别为（64.2±51.6）mm、34.7°±18.4°、-39.3°±11.9°；双侧组术前分别为（155.4±66.7）mm、68.3°±15.3°、0.6°±18.1°，术后即刻分别为（53.9±45.9）mm、24.9°±14.0°、-40.7°±9.2°，末次随访时分别为（48.6±48.5）mm、25.6°±15.7°、-39.8°±8.5°。2组患者SVA、GK、LL术后均较术前改善明显，差异均有统计学意义（P值均<0.05）；而末次随访与术后即刻比较，各项指标差异均无统计学意义（P值均>0.05）。2组间比较：除双侧组术后即刻的OVA（28.6°±8.8°）明显大于单侧组（19.9°±10.4°），差异有统计学意义（t=-2.42，P=0.023）外，其余影像学参数（SVA、GK、LL、AFS）组间比较差异均无统计学意义（P值均>0.05）。（2）29例患者中有4例出现并发症：单侧组2例（1例术后体位性臂丛神经麻痹、1例术后6年截骨椎水平卫星棒未固定侧断棒），双侧组2例均为术中截骨椎脱位，2组差异无统计学意义（P=1.000）。 结论 PSO联合卫星棒技术治疗AS胸腰椎后凸畸形可获得满意的矫正效果，并有效预防术后矫正丢失和断棒现象。 Objective This study aims to investigate the clinical outcomes of pedicle subtraction osteotomy (PSO) combined with satellite rod technique in the treatment of thoracolumbar kyphosis in ankylosing spondylitis (AS). Methods This study adopted a retrospective cohort. Twenty-nine patients with AS (26 males and 3 females) who underwent single-level PSO combined with satellite rod technique in the Drum Tower Hospital of Nanjing University Medical School from September 2016 to June 2021 were retrospectively reviewed. The patients had an average age of 18 to 55 (35.5±9.9) years and divided into two groups according to the use of satellite rod unilaterally or bilaterally around the osteotomy area: 13 patients were in the unilateral group and 16 patients were in the bilateral group. Observation indicators included the following. (1) The corrective effect of patients was measured based on lateral full-spine X-ray. Radiographic parameters including sagittal vertical axis (SVA), lumbar lordosis (LL), and global kyphosis (GK) were compared between the two groups preoperatively, postoperatively, and at the last follow-up. Osteotomized vertebral angle (OVA) and angle of fused segments (AFS) were compared postoperatively and at the final follow-up. (2) The incidence of complications between the two groups was compared and the mechanical complication of rod breakage were observed. Results No statistical difference was observed in age, gender, and follow-up period between the two groups (all P values>0.05). Twenty-nine patients with AS received surgical treatment successfully and were followed up for 12-72 (26.4±10.7)months. (1) Based on comparison of data within the group, the postoperative SVA, GK, and LL were (64.1±42.5) mm, 34.4°±20°, and -44.0°±10.8°, respectively, and at the last follow-up values were (64.2±51.6) mm, 34.7°±18.4°, and -39.3°±11.9°, respectively, and before surgery, they were (162.1±53.3) mm, 79.7°±16.8°, -9.5°±20.4°, respectively in the unilateral group. In the bilateral group, the postoperative SVA, GK, and LL were (53.9±45.9) mm, 24.9°±14.0°, and -40.7°±9.2°, and the values at the last follow-up were (48.6±48.5) mm, 25.6°±15.7°, and -39.8°±8.5°, respectively, and before surgery they were (155.4±66.7) mm, 68.3°±15.3°, 0.6°±18.1°, respectively. All of above-mentioned parameters were significantly improved compared with the preoperative values, and the differences were statistically significant (allP values<0.05). However, no significant difference was observed between the final follow-up and immediate postoperative parameters (allP values>0.05). Based on comparison of data between two groups (SVA, GK, LL, AFS), no statistically significant difference was detected in the radiographic parameters, except that the postoperative OVA was significantly greater in the bilateral group (28.6°±8.8°vs. 19.9°±10.4°, t=-2.42, P=0.023). (2) Surgical complications occurred in four of the 29 patients. The complications in the unilateral group included 1 case of rod fracture on the side without satellite rod at the level of the osteotomized vertebra that occurred in 6 years after operation and 1 case of postoperative positional brachial palsy. The bilateral group included 2 cases of osteotomized vertebral subluxation. The incidence of complications was not significantly different between the two groups (P=1.000). Conclusion The application of PSO combined with satellite rod technique in the treatment of AS-related thoracolumbar kyphosis could achieve satisfactory correction and effectively prevent mechanical complications and correction loss.
Curative effect of pedicle subtraction osteotomy combined with satellite rod for thoracolumbar kyphosis secondary to ankylosing spondylitis
Objective This study aims to investigate the clinical outcomes of pedicle subtraction osteotomy (PSO) combined with satellite rod technique in the treatment of thoracolumbar kyphosis in ankylosing spondylitis (AS). Methods This study adopted a retrospective cohort. Twenty-nine patients with AS (26 males and 3 females) who underwent single-level PSO combined with satellite rod technique in the Drum Tower Hospital of Nanjing University Medical School from September 2016 to June 2021 were retrospectively reviewed. The patients had an average age of 18 to 55 (35.5±9.9) years and divided into two groups according to the use of satellite rod unilaterally or bilaterally around the osteotomy area: 13 patients were in the unilateral group and 16 patients were in the bilateral group. Observation indicators included the following. (1) The corrective effect of patients was measured based on lateral full-spine X-ray. Radiographic parameters including sagittal vertical axis (SVA), lumbar lordosis (LL), and global kyphosis (GK) were compared between the two groups preoperatively, postoperatively, and at the last follow-up. Osteotomized vertebral angle (OVA) and angle of fused segments (AFS) were compared postoperatively and at the final follow-up. (2) The incidence of complications between the two groups was compared and the mechanical complication of rod breakage were observed. Results No statistical difference was observed in age, gender, and follow-up period between the two groups (all P values>0.05). Twenty-nine patients with AS received surgical treatment successfully and were followed up for 12-72 (26.4±10.7)months. (1) Based on comparison of data within the group, the postoperative SVA, GK, and LL were (64.1±42.5) mm, 34.4°±20°, and -44.0°±10.8°, respectively, and at the last follow-up values were (64.2±51.6) mm, 34.7°±18.4°, and -39.3°±11.9°, respectively, and before surgery, they were (162.1±53.3) mm, 79.7°±16.8°, -9.5°±20.4°, respectively in the unilateral group. In the bilateral group, the postoperative SVA, GK, and LL were (53.9±45.9) mm, 24.9°±14.0°, and -40.7°±9.2°, and the values at the last follow-up were (48.6±48.5) mm, 25.6°±15.7°, and -39.8°±8.5°, respectively, and before surgery they were (155.4±66.7) mm, 68.3°±15.3°, 0.6°±18.1°, respectively. All of above-mentioned parameters were significantly improved compared with the preoperative values, and the differences were statistically significant (allP values<0.05). However, no significant difference was observed between the final follow-up and immediate postoperative parameters (allP values>0.05). Based on comparison of data between two groups (SVA, GK, LL, AFS), no statistically significant difference was detected in the radiographic parameters, except that the postoperative OVA was significantly greater in the bilateral group (28.6°±8.8°vs. 19.9°±10.4°, t=-2.42, P=0.023). (2) Surgical complications occurred in four of the 29 patients. The complications in the unilateral group included 1 case of rod fracture on the side without satellite rod at the level of the osteotomized vertebra that occurred in 6 years after operation and 1 case of postoperative positional brachial palsy. The bilateral group included 2 cases of osteotomized vertebral subluxation. The incidence of complications was not significantly different between the two groups (P=1.000). Conclusion The application of PSO combined with satellite rod technique in the treatment of AS-related thoracolumbar kyphosis could achieve satisfactory correction and effectively prevent mechanical complications and correction loss.
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