Objective: To introduce a self-designed adjustable operation frame and explore the feasibility and safety in the treatment of severe kyphosis secondary to ankylosing spondylitis with posterior osteotomy.
Methods: Between March 2016 and May 2018, 7 cases of severe kyphosis secondary to ankylosing spondylitis were treated with posterior osteotomy using self-designed adjustable operation frame with prone position. There were 5 males and 2 females with an average age of 49.4 years (range, 40-55 years). The disease duration was 10-21 years (mean, 16.7 years). The apical vertebrae of kyphosis were located at T 11 in 2 cases, T 12 in 1 case, L 1 in 1 case, and L 2 in 3 cases. Among the 7 cases, 2 were classified as typeⅠ, 4 as type ⅡB, and 1 as type ⅢA according to 301 classification system. There was no neurological deficit of all cases; but 1 case suffered bilateral hip joints ankylosed in non-functional position. The parameters of chin-brow vertical angle (CBVA), global kyphosis (GK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sagittal vertical axis (SVA) were measured; and the operation time, the intraoperative blood loss, and the complications were also collected and analyzed.
Results: All operations completed successfully. The operation time was 310-545 minutes (mean, 409.7 minutes) and the intraoperative blood loss was 1 500-2 500 mL (mean, 1 642.9 mL). There were 2 cases treated with one-level osteotomy of sagittal translation, 1 case of radiculopathy symptom of L 3, and 3 cases of tension of abdominal skin. All patients were followed up 20-35 months (mean, 27.9 months). There were significant differences in CBVA, GK, TLK, LL, and SVA between pre- and post-operation ( P<0.05); but no significant difference between 1 week after operation and last follow-up ( P>0.05). All the osteotomies and bone grafts fused well and no complications of loosening and breakage of internal fixator occurred during the follow-up.
Conclusion: In the posterior osteotomy for correction of severe kyphosis secondary to ankylosing spondylitis, the self-designed adjustable operation frame is convenient for the patient to be placed in prone position. It is safe, feasible, and effective to perform osteotomy correction with the aid of the self-designed adjustable operation frame.
目的: 介绍一种自主设计的可调式手术体位架，探讨其应用于强直性脊柱炎重度后凸畸形后路截骨矫形术中的可行性及有效性。.
方法: 2016 年 3 月—2018 年 5 月，在 7 例强直性脊柱炎重度后凸畸形患者后路截骨矫形术中，使用自主设计的可调式手术体位架以获得俯卧位手术体位。其中男 5 例，女 2 例；年龄 40～55 岁，平均 49.4 岁。强直性脊柱炎病程 10～21 年，平均 16.7 年。顶椎位于 T 11 2 例，T 12 1 例，L 1 1 例，L 2 3 例；依据 301 分型标准：Ⅰ型 2 例，ⅡB 型 4 例，ⅢA 型 1 例。1 例合并双侧髋关节非功能位强直，7 例均无脊髓神经受损症状。手术前后测量患者颌眉角（chin-brow vertical angle，CBVA）、脊柱整体后凸角（global kyphosis，GK）、胸腰段后凸角（thoracolumbar kyphosis，TLK）、腰椎前凸角（lumbar lordosis，LL）、矢状位垂直轴（sagittal vertical axis，SVA），记录手术时间、术中出血量以及并发症发生情况。.
结果: 7 例患者手术均顺利完成；手术时间 310～545 min，平均 409.7 min；术中出血量 1 500～2 500 mL，平均 1 642.9 mL。其中 2 例单椎体截骨发生矢状面移位，1 例术后出现单侧肢体 L 3 根性症状，3 例术后腹部皮肤张力大。术后患者均获随访，随访时间 20～35 个月，平均 27.9 个月。术后 1 周及末次随访时 CBVA、GK、TLK、LL、SVA 与术前比较，差异均有统计学意义（ P<0.05）；术后 1 周及末次随访时比较，差异均无统计学意义（ P>0.05）。随访期间未见内固定物松动、断裂等并发症，所有截骨及植骨均获骨性融合。.
结论: 强直性脊柱炎重度后凸畸形后路截骨矫形术中，采用自主设计的可调式手术体位架便于患者俯卧体位的安放，在其辅助下进行截骨矫形安全、可行，疗效满意。.
Keywords: Self-designed adjustable operation frame; ankylosing spondylitis; kyphosis; posterior osteotomy.