The Pedicle Subtraction Osteotomy Joint V-shaped Cut Bone Correction AS Heavy Wheel Shape Protrusion Deformity After Clinical Analysis

Objective:to analyse ankylosing spondylitis complicated with spinal sagittal protrusion deformity patients after severe wheel shape through pedicle vertebral wedge osteotomy combined v-shaped osteotomy+long segmental pedicle screw internal fixation system orthodontic clinical effect. Methods:from June 2002 to November 2002 in our spine surgery using the pedicle vertebral wedge osteotomy combined v-shaped osteotomy +long segmental pedicle screw fixation correction ankylosing spondylitis complicated with spinal sagittal exist severe thoracic segments, lumbar segments in the chest and waist segment of the protruding after 38 patients with malformed wheels, are male, age 22-56 years old, average 36.3 years. After measuring spinal convex Angle, lumbar lordosis, jaw Angle, eyebrow C7 plumb line to evaluate correction effect, application of Japanese orthopaedic society JOA score method to evaluate curative effect, and the last follow-up of patients with preoperative ODI score, evaluation of the patient’s deformity correction effect and the patient’s quality of life. Results:38 patients in 36 cases received follow-up, 1 case of patients with postoperative death in July for reasons unknown,1 case was followed up for 5 months, the whole spine after the biggest convex Cobb Angle by surgery before 88.6° ± 9.8°,(70°～110°) corrected to 33.7° ± 7.2° (23°～50.1°), compared with the preoperative difference was statistically significant (P<0.05), the average correct rate of 64.3%; Chin-brow vertical angle by an average of 68.2° ± 16.3°(46°～120°) correction to 10.4° ± 6.2°(5°～37.6°) (P< 0.05), the average correct rate is 76.5%; The C7 plumb line by preoperative 34.4 ± 11.5 (15～55) average correction to 10.6±3 (5.4～16.7) (P<0.05), the average correct rate of 81.2%; Followed up for 24～48 months, an average of 33.5 months, at the time of the last follow-up, with full spinal postoperative 1 week after the biggest convex Cobb Angle, jaw Angle of eyebrow and C7 plumb line to compare difference has no statistical significance (P>0.05). Preoperative JOA:13.4±5.3points, postoperatie JOA:23.7±3.3 points(P<0.05), two groups of data, the difference was statistically significant at the time of the last follow-up JOA score improved obviously earlier. Treatment period was72.5±4.85, treatment period optimal:28 cases, good:5 cases, medium:3 case. ODI score by preoperative31.6 ± 9.5, at the time of the last follow-up to improve to 13.9±7.8 (P<0.05), two groups of data difference was statistically significant, curative effect is satisfied. Whole spine X ray film and shown good fixed position in all patients with postoperative, no broken nails, broken rod, pull out wait for a phenomenon. Conclusion:For the AS convex deformity patients after severe wheel shape, through pedicle vertebral osteotomy with v-shaped cut bone therapy is a safe and effective method, can better correct the spinal sagittal curvature also can reduce the risk of sagittal Angle is excessive, make the stress distribution in the section, the shortening of the spinal and epidural buckling distributed in relatively long segments, can avoid within short segmental spinal cord shortening and epidural excessive buckling and cause nerve damage...