Objective: To explore the clinical effect of one-staged modified Halo-pelvic traction combined with two-stage surgery for severe spinal deformity accompanied by respiratory disorder.

目的 探讨分期手术治疗成人重度先天性脊柱侧凸合并无症状脊髓栓系的临床疗效.方法 2020年4月至2021年6月北京朝阳急诊抢救中心脊柱外科收治的成人重度先天性脊柱侧凸合并无症状脊髓栓系患者35例;男13例,女22例;年龄21～39(30.06±4.81)岁.采用一期先行脊髓栓系松解加终丝横断,二期行头盆环牵引联合三期手术矫形.记录脊髓栓系松解术后、牵引期间及矫形术后并发症;在站立位全脊柱正位X线片上测量牵引前、牵引终止时及终末矫形术后全脊柱冠状面Cobb角、C7-S1偏移距离和顶椎偏移距离.结果 脊髓栓系术后观察时间为(8.03±1.67)d,持续牵引时间为(77.6±16.24)d.牵引前身高变化为(143.94±10.41)cm、牵引终止时为(156.26±9.44)cm、终末矫形术后为(157.34±9.24)cm.牵引终止时身高较牵引前增加了(12.31±5.32)cm;终末矫形术后身高较牵引终止时增加了(1.07±1.01)cm;终末矫形术后身高较牵引前增加了(13.40±5.33)cm.牵引前后、矫形前后身高差异有统计学意义(P<0.05).牵引前、牵引终止时及终末矫形术后全脊柱冠状面Cobb角分别为110～175(131.77±16.73)°、53～134(86.00±20.05)°、30～110(69.74±17.96)°,差异均有统计学意义(P<0.05).全脊柱冠状面牵引矫形率为12.5％ ～55.5％(34.8％ ±9.9％);全脊柱冠状面总矫正率为23.9％ ～72.73％(60.1％ ±7.6％);牵引前、牵引终止时及终末矫形术后C7-S1偏移距离分别为0.00～150.00(44.46±36.01)、0.00～98.00(22.84±25.18)、0.00～67.00(11.71±15.41)mm,差异均有统计学意义(均P<0.05);牵引前、牵引终止时及终末矫形术后顶椎偏移距离分别为19.80～170.00(94.32±36.70)、0.00～124.00(70.86±26.98)、0.00～106.00(55.70±23.78)mm,差异均有统计学意义(均P<0.05).结论 一期先行脊髓栓系松解加终丝横断,二期行头盆环牵引联合三期手术治疗成人重度先天性脊柱侧凸合并无症状脊髓栓系是一种安全、有效的方法.

目的 评估腰椎后路截骨手术矫正强直性脊柱炎(ankylosing spondylitis,AS)合并重度胸腰椎后凸畸形的临床疗效.方法 2020-10至2021-06共收治AS合并胸腰椎后凸畸形患者11例,其中合并Andersson损害(Andersson lesion,AL)1例,平均(32.8±3.4)岁;患者均有腰背部疼痛及后凸畸形,术前胸椎后凸角59.36°±12.63°;腰椎前凸角-0.54°±32.89°;颏眉角31.82°±12.25°.10例AS后凸畸形患者均在L2行经椎弓根椎体截骨术(pedicle subtraction osteotomy,PSO),1例AS合并AL后凸畸形患者采用腰椎后路经损害处清创、截骨矫形.综合评价术后影像学、临床疗效及并发症.结果 患者手术顺利,耐受性良好,术后平均胸椎后凸角55.18°±11.59°,腰椎前凸角43.91°±19.14°,颏眉角1.82°±0.83°.患者均获随访,无血管、神经损伤,无应力性骨折等并发症.结论 经L2行PSO截骨矫正AS重度后凸畸形,合并AL后凸畸形行经损伤处截骨矫形,术后效果安全可靠.

Abstract Purpose: To analyze the characteristics of cardiopulmonary function in patients with ankylosing spondylitis (AS), and explore the influence of global kyphosis (GK) on cardiopulmonary function. Method: Clinical data of 46 AS patients with kyphosis admitted to our hospital from October 2021 to October 2022 were retrospectively analyzed. According to the to global kyphosis Angle, they were divided into severe group (GK > 95°), 23 cases in the moderate group (80° ≤ GK ≤ 95°). Cardiac structure, function and lung function parameters were compared between the two groups, and the effects of GK Angle on other parameters were analyzed by Pearson or Spearman correlation analysis. Result: The cardiac structure and function measurements in both groups were within the normal range, and the atrioventricular size in the severe group was significantly smaller than that in the moderate group (P < 0.05), left ventricular diastolic function parameters E/A, e’/a’ were significantly lower than those in moderate group (P < 0.05), and E/e’ was significantly higher than that in moderate group (P < 0.05). The lung function of the two groups was decreased to varying degrees. The restrictive ventilation function, small airway function and ventilation function parameters of the severe group were significantly lower than those of the moderate group (P < 0.05). Correlation analysis showed that GK Angle was significantly negatively correlated with left atrioventricular size (LAD, LVDD, LVSD) and diastolic function parameters (E/A, e’/a’) in AS patients (P < 0.05); GK Angle was negatively correlated with restrictive ventilation parameters in AS patients (P < 0.05). Conclusion: The GK Angle of AS affects the heart structure and diastolic function. The larger the GK Angle is, the smaller the left and right atventricle diameters are. In addition, GK Angle also affects left ventricular diastolic function. GK Angle is related to the degree of lung function impairment, and the larger the GK Angle, the worse the lung function.