A New Method for Calculating the Exact Angle Required for Spinal Osteotomy
A New Method for Calculating the Exact Angle Required for Spinal Osteotomy
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DOI：
10.1097/brs.0b013e31828b3299
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发表时间：
2013-05-01
期刊：
影响因子：
3
通讯作者：
Wang, Yan
中科院分区：
文献类型：
--
作者：
Song, Kai;Zheng, Guoquan;Wang, Yan
研究设计.前瞻性研究。评估一种确定强直性脊柱炎（AS）患者脊柱截骨术所需精确角度的新方法。保持矢状面平衡的理想方法是当骨盆和下肢关节处于中立位时，将躯干的重心转移到髋轴上。对于AS患者，已经探索了各种方法来计算所需的矫正角。然而，这些方法具有一些局限性。研究了20名接受脊柱截骨术矫正脊柱后凸畸形的AS患者。对所有患者进行术前和术后全脊柱和骨盆的全长独立式X线片检查。根据骨盆倾斜度计算出理想的术后骨盆倾斜度，并选择肺门铅垂线而不是C7作为躯干重心轴。然后，计算截骨水平所需的角度矫正。测量术前和术后放射学参数，包括Cobb T1-S1、骨盆发病率、骨盆倾斜度、骶骨倾斜度和矢状垂直轴。在术前和术后6个月随访时进行健康相关的生活质量评估，包括奥斯韦斯特里残疾指数和脊柱侧凸研究协会结果量表-22。术前Cobb T1-S1为52 °，术后为3 °（P < 0.001）。所有患者的术前和术后X线片参数均发生了变化，包括骨盆倾斜度（从30 °到11 °，P < 0.001）和矢状垂直轴（从18 cm到7 cm）减小，骶骨倾斜度（从16 °到35 °，P < 0.001）增加，但骨盆发病率无显著变化。术后6个月随访时，患者的健康相关生活质量评分较术前明显改善。该方法为AS校正提供了准确和可重复的计算。
Study Design. Prospective study.Objective. To assess a new method for determining the exact angle required for spinal osteotomy in patients with ankylosing spondylitis (AS).Summary of Background Data. The ideal method for maintaining sagittal balance is to shift the center of gravity of the trunk over the hip axis when pelvic and lower extremity joints are in the neutral position. For patients with AS, various methods have been explored to calculate the required corrective angle. However, these methods carry some limitations.Methods. Twenty patients with AS who underwent spinal osteotomy for correcting kyphotic deformity were studied. Pre- and postoperative full-length freestanding radiographs of the whole spine and pelvis were obtained for all patients. We calculated the ideal postoperative pelvic tilt according to pelvic incidence, and chose the plumbline of the hilus pulmonis rather than C7 as gravity axis of the trunk. Then, the necessary angular correction at the level of osteotomy was calculated. Pre- and postoperative radiological parameters, including Cobb T1-S1, pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured. Health related quality of life, including Oswestry Disability Index and Scoliosis Research Society outcomes instrument-22, were administered before surgery and at 6-month follow-up.Results. The preoperative and postoperative Cobb T1-S1 were 52 degrees and 3 degrees, respectively (P < 0.001). All patients demonstrated changes in preoperative to postoperative radiographical parameters including decreased pelvic tilt (from 30 degrees to 11 degrees, P < 0.001) and sagittal vertical axis (from 18 cm to 7 cm), increased sacral slope (from 16 degrees to 35 degrees, P < 0.001), but no significant change in pelvic incidence. Health related quality of life scores at 6-month follow-up had significantly improved compared with those before surgery.Conclusion. This method provides an accurate and reproducible calculation for AS correction.