Treatment of Andersson lesion-complicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy, a retrospective study
Treatment of Andersson lesion-complicating ankylosing spondylitis via transpedicular subtraction and disc resection osteotomy, a retrospective study
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DOI：
10.1007/s00586-015-4213-6
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发表时间：
2016-08-01
影响因子：
2.8
通讯作者：
Wang, Yan
中科院分区：
文献类型：
--
作者：
Zhang, Xuesong;Wang, Yao;Wang, Yan
强直性脊柱炎(AS)患者可发生Andersson病变(AL)。手术内固定和融合被认为是保守治疗不能解决的症状性急性白血病的主要治疗方法。然而，对于理想的管理，人们存在着很大的争议。本研究的目的是介绍我们的经验，探讨经椎弓根减压术和椎间盘切除截骨术治疗AL合并AS的疗效和可行性。2009年1月至2013年1月，连续17例Andersson病损合并强直性脊柱炎患者采用经椎弓根减压术和椎间盘切除截骨术治疗。所有患者均完成至少2年的随访，平均手术时间219min，术中平均出血量876ml，术前平均区域角度29.1A°，术后平均4.9A°，末次随访平均5.9A°。眼球角度由术前的59.1A°变为术后的24.7A°，矢状轴由153.7 mm变为41.1 mm。平均VAS评分由术前的6.4分降至术后的1.1分，ODI评分由术前的50.9分提高至末次随访时的16.9分。所有患者均获得了牢固的融合，椎弓根减压术和椎间盘切除截骨术获得了满意的脊柱后凸矫正、良好的融合和良好的临床效果，且出血量少，并发症少，为Andersson病变合并强直性脊柱炎患者提供了一种新的治疗方法。
Andersson lesion (AL) can occur in patients with ankylosing spondylitis (AS). Surgical instrumentation and fusion is considered the principle management in symptomatic AL that fails to resolve from a conservative treatment. However, there is significant controversy over the ideal management. The purpose of this study is to introduce our experience and explore the efficacy and feasibility of transpedicular subtraction and disc resection osteotomy technique for patients with AL-complicating AS.From January 2009 to January 2013, 17 consecutive patients with Andersson lesion-complicating ankylosing spondylitis treated with transpedicular subtraction and disc resection osteotomy technique were retrospectively reviewed. All patients completed a follow-up of at least 2 years.The average surgical time was 219 min with a mean intraoperative blood loss of 876 ml. The average preoperative regional angle was 29.1A degrees, 4.9A degrees postoperatively, and 5.9A degrees at the final follow-up. The global angle changed from 59.1A degrees preoperatively to 24.7A degrees after surgery with the sagittal vertical axis (SVA) changed from 153.7 to 41.1 mm. The mean VAS back pain scores decreased from 6.4 preoperatively to 1.1 postoperatively and the ODI score improved from 50.9 preoperatively to 16.9 at the final follow-up. Solid fusion was obtained in all patients.The transpedicular subtraction and disc resection osteotomy achieve satisfactory kyphosis correction, good fusion and favorable clinical outcomes with less blood loss and complications than other approaches, implying an alternative method in patients with Andersson lesion-complicating ankylosing spondylitis.