目的:成人脊柱畸形(ASD)手术后的原发性棒骨折是翻修的主要原因,最近的前瞻性多中心骨折率报告为11%-14%,到2年。因此,已探索添加补充棒以减少骨折。在这里,作者描述了他们的经验与一个新的髂附件棒技术,其中每个附件棒通过侧向连接器在尾端锚定到一个独立的髂螺栓,并通过侧对侧连接器沿螺纹连接到主杆。
方法:本回顾性研究,单中心病例系列包括在2019年3月至2023年8月期间接受了ASD胸腰椎/腰椎融合术的患者.基线人口统计数据,射线照相参数,手术特点,并发症,杆断裂,并收集了修订率。配对,双尾t检验用于比较术前和术后的影像学结果。通过卡方拟合优度测试将杆断裂率与先前的研究进行了比较。描述了髂附件棒放置技术。
结果:该研究包括82名患者(平均年龄66岁,51%女性,26%与先前融合),中位随访2年(IQR28-104周)。共有50例患者(61%)进行了≥2年的随访。每次手术平均涉及4个后柱截骨术和8个节段。Iliac辅助棒是钴铬,并在87%的构造中两侧放置。术后对准在以下参数方面显着改善:最大冠状Cobb角,分数曲线,矢状垂直轴,腰椎前凸,胸椎后凸,和骨盆发生率与腰椎前凸不匹配(所有比较p<0.001)。50例随访时间≥2年的患者,棒断裂发生在1(2.0%),这是偶然发现的,不需要干预。目前的杆断裂率明显低于作者历史报道的传统双杆结构的21%的体制率,在最近的前瞻性多中心研究中报告了11%-14%,这些研究使用了传统和补充杆结构(所有比较p<0.05)。再次手术12例(14.6%);近端交界性脊柱后凸7例(8.5%),伤口并发症5例(6.1%)。
结论:在这里,作者描述了他们在接受ASD手术的患者中使用一种新型的髂辅助棒技术预防棒骨折的经验。在这项研究中,2年的杆骨折率(2.0%)明显低于作者的历史双杆骨折率,和其他前瞻性多中心调查。需要进行更长时间随访的未来研究来确定该技术的耐久性。
OBJECTIVE: Primary rod fracture after surgery for adult spinal deformity (ASD) is a leading cause of revision, with recent prospective multicenter fracture rates reported at 11%-14% by 2 years. Consequently, the addition of supplemental rods has been explored to reduce fractures. Here the authors describe their experience with a novel iliac accessory rod technique in which each accessory rod anchors to an independent iliac bolt caudally via lateral connector, and attaches to the primary rod rostrally via side-to-side connector.
METHODS: This retrospective, single-center
case series included patients who underwent thoracolumbar/lumbar fusion for ASD between March 2019 and August 2023. Data on baseline demographics, radiographic parameters, surgical characteristics, complications, rod fracture, and revision rates were collected. Paired, 2-tailed t-tests were used to compare pre- and postoperative radiographic outcomes. Rod fracture rates were compared to prior investigations via chi-square goodness of fit testing. The technique for iliac accessory rod placement is described.
RESULTS: The study consisted of 82 patients (mean age 66 years, 51% female, 26% with prior fusion) with a median follow-up of 2 years (IQR 28-104 weeks). A total of 50 patients (61%) had ≥ 2-year follow-up. Each surgery involved an average of 4 posterior column osteotomies and 8 segments. Iliac accessory rods were cobalt chromium and were placed bilaterally in 87% of constructs. Postoperative alignment improved significantly in the following parameters: maximum coronal Cobb angle, fractional curve, sagittal vertical axis, lumbar lordosis, thoracic kyphosis, and pelvic incidence to lumbar lordosis mismatch (p < 0.001 for all comparisons). Of 50 patients with ≥ 2-year follow-up, rod fracture occurred in 1 (2.0%), which was incidentally found and required no intervention. The present rod fracture rate was significantly lower than the authors\' historically reported institutional rate of 21% for traditional dual-rod constructs, and the 11%-14% reported in recent prospective multicenter studies that used traditional and supplemental rod constructs (p < 0.05 for all comparisons). Reoperation occurred in 12 patients (14.6%); 7 (8.5%) for proximal junctional kyphosis and 5 (6.1%) for wound complication.
CONCLUSIONS: Here the authors describe their experience with a novel iliac accessory rod technique to prevent rod fracture in patients undergoing surgery for ASD. The 2-year rod fracture rate (2.0%) in this study is significantly lower than the authors\' historical dual-rod fracture rate, and other prospective multicenter investigations. Future studies with longer follow-up are needed to determine the durability of this technique.