| Chapter 2(Section 1)Does postoperative PI-LL mismatching affect surgical outcomes in thoracolumbar kyphosis associated with ankylosing spondylitis patients?Objective To investigate if pelvic incidence(PI)and lumbar lordosis(LL)mismatching affects surgical outcomes for ankylosing spondylitis(AS)related kyphosis following 1-level lumbar pedicle subtraction osteotomy(PSO).Methods AS patients with thoracolumbar kyphosis,who underwent 1-level lumbar PSO from March 2006 and February 2014 in our institution,were retrospectively reviewed.The radiographic measurements and health-related quality of life(HRQOL)scores,including Oswestry Disability Index(ODI)and Visual Analogue Scale(VAS)for pain,were recorded at baseline and the last follow-up.Patients were divided into 2 groups according to PI-LL matching or not postoperatively(Match Group,Mismatch Group),and comparison of the aforementioned parameters between the two groups was performed.Results Seventy patients were enrolled with a mean age of 34.60±9.45 years(range,17 yrs.to 59 yrs.).Among them,44 were included in the Match Group and 26 in the Mismatch Group.At baseline,patients in the Match Group had larger 1L(-2.45°vs 6.58°,P=0.014)and smaller pelvic tilt(PT,34.09°vs 43.23°,P=0.001)than patients in the Mismatch Group.At the last follow-up,along with larger LL(-43.39°vs-35.54°,P=0.004)and smaller PT(22.11°vs 29.54°,P=0.001),Match Group patients also had significantly smaller sagittal vertical axis(SVA,3.31 cm vs 6.27 cm,P=0.001)than those in the Mismatch Group.Seventy-five percent(33/44)of the patients in the Match Group had a SVA<5 cm at the last follow-up,while in the Mismatch Group,only 35%(9/26)of the patients did.However,no significant difference was found between the two groups regarding HRQOL scores.Conclusion Patients with postoperative PI-LL matching were more likely to have a better correction of SVA;they also tended to have a smaller preoperative PT.However,PI-LL mismatching didn't affect HRQoL scores at the last follow-up,which was different from the results of previous studies in the settings of ASD.Chapter 2(Section 2)Does relocation of the apex after osteotomyaffect surgical and clinical outcomes in ankylosing spondylitis patients with thoracolumbar kyphosis?Objective Relocation of the apex is often found in patients with ankylosing spondylitis(AS)-associated thoracolumbar/lumbar kyphosis after corrective surgery.This study evaluates the influence of different postoperative apex locations on surgical and clinical outcomes of osteotomy for AS patients with thoracolumbar kyphosis.Methods Sixty-two patients with a mean age of 34.6±9.7 years(range,17-59 years)and a minimum of 2 years of follow-up,who underwent 1-level lumbar pedicle subtraction osteotomy(PSO)for AS-related thoracolumbar kyphosis,were enrolled,as well as 62 age-matched healthy individuals.Patients were divided into 2 groups according to the postoperative location of the apex(Group 1,T8 or above;Group 2,T9 or below).Demographic data,radiographical measurements(including 3 postoperative apex-related parameters)and clinical outcomes were compared between the 2 groups preoperatively,postoperatively and at the last follow-up.Furthermore,a subgroup analysis was performed among patients with postoperative apex located at T6-T11 and postoperatively the entire AS cohort was compared with normal controls regarding the apex location of the thoracic spine.Results In the majority of the enrolled patients,the apex location changed from T12-L2 preoperatively to T6-T9 postoperatively.The sagittal vertical axis(SVA)differed significantly both postoperatively(25.7 mm vs 59.1 mm,P=0.001)and at the last follow-up(32.9 mm vs 61.3 mm,P=0.003)between the 2 groups,and the patients in Group 1 had significantly smaller horizontal distance between the C7-vertical line and the apex(DCA)than the patients in Group 2(69.1 mm vs 103.1 mm,P=0.001).Subgroup analysis demonstrated similar results,showing that the patients with postoperative apex located at T8 or above had an average SVA<47mm.Notably,a significant correlation was found between postoperative SVA and DCA(r=0.642,P=0.001).Patients underwent osteotomy at L3 had limited apex relocation but larger SVA correction than those at LI or L2.However,no significant difference was found in health-related quality of life(HRQOL)between the 2 groups.Conclusion AS patients with apex located at T8 or above after surgery tended to have better SVA correction(within 47 mm)than those who had a more caudally located apical vertebra.For ideal postoperative apex relocation,a higher(closer to or at the preoperative apex)level of osteotomy is more likely to obtain the surgical goal.Chapter 3 Differential expression of IncRNA in the serum of ankylosing spondylitis patientsObjective To investigate the differential expression of IncRNA in the serum of ankylosing spondylitis(AS)patients,with the goal of finding new potential biomarkers for the diagnosis and targeted treatment of AS.Methods A total of 19 AS patients and 19 age-matched healthy controls from January 2017 to September 2017 were recruited.High-throughput IncRNA sequencing technology was used to detect differently expressed IncRNAs in the serum of 3 AS patients and 3 healthy controls.And real-time quantitative polymerase chain reaction(RT-qPCR)was used to confirm the above-mentioned results.Results A total of 41 up-regulated and 2 down-regulated IncRNAs were detected in AS patients.However,this result could not be confirmed by RT-qPCR with a larger sample size.Conclusion Differential expression of IncRNA might not exist in the peripheral blood of AS patients,further studies regarding IncRNA in AS could focus more on its differential expression and function in the focal tissue. |
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