| Background Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that causes characteristic spinal deformities, such as flattening of the normal lumbar lordosis and thoracolumbar kyphosis, which may lead to impaired ability of walking, standing, lying on the back. So far, some methods to reconstruct the sagittal balance have been reported. However, most of the methods are for patients without cervical spondylosis and hip involvement, and few deformity design has ever been made for patients with cervical spondylosis or hip involvement.Objective 1.To investigate optimal chin-brow vertical angle (CBVA) for AS thoracolumbar kyphosis with cervical ankylosis.2.To investigate clinical effects of spinal osteotomy for AS thoracolumbar kyphosis with hip involvement.Material and Methods 1.25 AS thoracolumbar kyphotic patients with cervical spondylosis were studied, and pre-and post-operative CobbT5-S1 and PT (pelvic tilt) were obtained on lateral X-ray of patients with free-standing posture. Moreover, the 25 patients were assessed on function and expection of visual field related to quality of life by questionnaire before and after surgery. Pre-and post operative CBVA were obtained on lateral photos of patients with free-standing posture, then,50 cases were included, and we divided them into 6 groups according to CBVA without regard to surgery (Group A, CBVA<0°; Group B,0°≤CBVA<10°; Group C,10°≤CBVA<20°; Group D,20°≤CBVA<30°; Group E,30°≤CBVA<40°; Group F, CBVA≥40°).2.37 AS thoracolumbar kyphotic patients were studied, and we divided them into 2 groups according to whether with hip involvement (Group A, patients without hip pain and range of flexion-extension motion≥120°; Group B, patients with hip pain or range of flexion-extension motion<120°or with total hip replacement (THR)). Moreover, patients with hip involvement were divided into 3 groups (Group B1, patients with no need for THR; Group B2, patients with spinal correction before THR; Group3, patients with THR before spinal correction). Chief complaint in post-operation of each patient and whether it leaded to poor life were studied; SRS-22, BASFI and Harris were used to assess the quality of life of patients in pre- and post-operation.Results 1.In overall evaluation, Group C (10-20°) obtained the optimal expection (p<0.05); Group B, C and D(0-30°)obtained better function (p<0.05). In appearance item, better results were obtained in Group A, B and C (<20°) than the other groups both in function and expection (p<0.05). In outdoor activity, Group A, B, C and D (< 30°) were better in most of the items (p<0.05). In indoor activity, Group C and D(10-30°)were much better (p<0.05). In prc- and post-operation, CBVA was 43±16° and 7±11° respectively; CobbT5-S1 was 56±20°and 2±23 respectively; PT was 42±11°and 25± 11° respectively.2. In pre-operation, Group A had better quality of life than Group B, and it was the same in post-operation. Both Group A and Group B had better activities after spinal surgery to some degree, especially activities such as standing and walking, though some few activities (squating, putting on socks et al) became worse. Clinical results associated with hip activities were not as good as expected in Group B1; patients in Group B2 had poor activities after spinal correction, but good results were obtained after subsequent THR; patients in Group3 with THR first had improved activities after the surgery, and better results were abtained after subsequent spinal correction. However, some patients in Group3 had difficulty to sit.Conclusion 1. AS thoracolumbar kyphotic patients with cervical ankylosis can have the best quality of life and satisfied subjective appearance with CBVA between 10° to 20°. Change of CBVA in pre- and post-operation depends on spinal correction and different pelvic compensation.2. Spinal correction changes the range of hip movement in AS thoracolumbar kyphotic patients, and it can restore the useful range of hip movement. For the patients with hip involvement, saving useful range of hip movement is meaningful. For the patients who undergoing THR first, cup functional position is not a good choice. For patients both need spinal correction and THR, undergoing THR first can have better activities than undergoing spinal correction first in the period between the two surgeries. |
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