背景:尽管采用了现代固定技术,成人脊柱畸形(ASD)手术后脊柱骨盆固定失败(SPFF)的范围为4.5%至38.0%,大约50%需要重新手术。与ASD手术后其他经过充分研究的并发症相比,对SPFF的发生率和预测因素知之甚少。
目的:鉴于SPFF的高发生率和需要再次手术治疗,本系统综述和荟萃分析的目的是报告ASD手术后SPF的发生率和失败机制.
方法:文献检索在四个数据库中进行:Medline通过PubMed和Ovid,通过EBSCO的SPORTDiscus,科克伦图书馆通过威利,还有Scopus.研究纳入标准为接受ASD手术的患者,SPFF的报告率和故障机制的类型,18岁以上的患者,至少1年随访,和队列或病例对照研究。从每一项研究中,我们收集了一般的人口统计信息(年龄,性别,和体重指数),主要/修订,ASD类型,和失效模式(螺钉松动,杆断裂,假关节,螺钉失效,SI关节痛,螺钉突起,设置插头移位,和骶骨骨折),并记录每种类型的SPF总体发生率以及失败率。对于故障率的评估,我们需要至少12个月的随访和影像学评估.
结果:在206项研究中,14例符合纳入标准,包括3570例接受盆底器械ASD手术的ASD患者(平均年龄65.5±3.6岁)。平均SPFF率为22.1%(范围3-41%)。对失败类型进行分层后,假关节组的平均SPFF率为23.3%;棒骨折组的平均SPFF率为16.5%;in骨螺钉松动组为13.5%;SIJ疼痛组为7.3%;in骨螺钉组为6.1%;固定栓移位组为3.6%;the骨骨折组为1.1%;and骨螺钉突出组为1%。
结论:ASD术后SPFF的总发生率为22.1%。最常见的失败机制是假关节,杆断裂,髂螺钉松动。SPFF的研究仍然是异质的,并且需要对什么构成SPFF进行一致的定义。这项研究可能使外科医生能够为患者提供具有骨盆固定结构的特定结构,以最大程度地减少失败的风险。
BACKGROUND: Despite modern fixation techniques, spinopelvic fixation failure (SPFF) after adult spinal deformity (ASD) surgery ranges from 4.5 to 38.0%, with approximately 50% requiring reoperation. Compared to other well-studied complications after ASD surgery, less is known about the incidence and predictors of SPFF.
OBJECTIVE: Given the high rates of SPFF and reoperation needed to treat it, the purpose of this systematic
review and meta-analysis was to report the incidence and failure mechanisms of SPF after ASD surgery.
METHODS: The literature search was executed across four databases: Medline via PubMed and Ovid, SPORTDiscus via EBSCO, Cochrane Library via Wiley, and Scopus. Study inclusion criteria were patients undergoing ASD surgery with spinopelvic instrumentation, report rates of SPFF and type of failure mechanism, patients over 18 years of age, minimum 1-year follow-up, and cohort or case-control studies. From each study, we collected general demographic information (age, gender, and body mass index), primary/revision, type of ASD, and mode of failure (screw loosening, rod breakage, pseudarthrosis, screw failure, SI joint pain, screw protrusion, set plug dislodgment, and sacral fracture) and recorded the overall rate of SPF as well as failure rate for each type. For the assessment of failure rate, we required a minimum of 12 months follow-up with radiographic assessment.
RESULTS: Of 206 studies queried, 14 met inclusion criteria comprising 3570 ASD patients who underwent ASD surgery with pelvic instrumentation (mean age 65.5 ± 3.6 years). The mean SPFF rate was 22.1% (range 3-41%). Stratification for type of failure resulted in a mean SPFF rate of 23.3% for the pseudarthrosis group; 16.5% for the rod fracture group; 13.5% for the iliac screw loosening group; 7.3% for the SIJ pain group; 6.1% for the iliac screw group; 3.6% for the set plug dislodgement group; 1.1% for the sacral fracture group; and 1% for the iliac screw prominence group.
CONCLUSIONS: The aggregate rate of SPFF after ASD surgery is 22.1%. The most common mechanisms of failure were pseudarthrosis, rod fracture, and iliac screw loosening. Studies of SPFF remain heterogeneous, and a consistent definition of what constitutes SPFF is needed. This study may enable surgeons to provide patient specific constructs with pelvic fixation constructs to minimize this risk of failure.