背景:成人脊柱畸形(ASD)的手术通常涉及长节段后部器械,这会在近端交界处引入应力,从而导致近端交界处后凸畸形(PJK)或近端交界衰竭(PJF)。最近,建议在近端连接处使用系绳作为缓冲过渡应力和降低PJK/PJF风险的一种手段。我们的目的是总结PJK/PJF预防近端交界系绳的临床文献。
方法:2000年1月1日至2022年11月10日之间发表的文章是通过PubMed搜索,使用搜索术语“脊柱外科”的组合来确定的,\"\"ASD,“\”并发症,\"\"手术,\"\"PJK,\"\"PJF,\"\"系绳,“\”亚层流带,“和”预防。“对病人的数量没有限制,手术适应症,或外科手术。对相关文章进行了回顾和总结。
结果:确定了15篇文章,包括2个前瞻性队列(II级),10个回顾性队列(III级),和3个回顾性病例系列(IV级)。所有研究均在2016年至2022年之间发表,所有研究均针对ASD患者人群。每个研究的平均年龄从55岁到69岁,大多数研究的平均随访时间至少为12个月(范围,5.5-45.4个月)。11项研究使用了聚乙烯系绳,2根使用的软层状电缆,和2使用半腱同种异体移植。系绳延伸至UIV+1或UIV+2,穿过或围绕棘突,13项研究在其余两项研究中,系绳在UIV+1处通过层下层。14项研究赞成使用系绳来降低PJK/PJF率,其中一个在系绳组和无系绳组之间显示出相似的PJK率。
结论:PJK/PJF仍然是ASD手术的主要挑战。大多数早期研究表明,使用系绳进行韧带增强可能有助于减轻PJK/PJF的发展。然而,PJK/PJF的多因素病因使得任何单一技术都不可能解决这一复杂问题.需要进一步的研究,不仅要解决连接系绳的有效性,还要澄清是否有最佳的系绳配置,系绳材料,和系绳张力。
方法:3.
BACKGROUND: Surgery for adult spinal deformity (ASD) often involves long-segment posterior instrumentation that introduces stress at the proximal junction that can result in proximal junctional kyphosis (PJK) or proximal junctional failure (PJF). Recently, the use of tethers at the proximal junction has been proposed as a means of buffering the transitional stresses and reducing the risk of PJK/PJF. Our objectives are to summarize the clinical literature on proximal junctional tethers for PJK/PJF prophylaxis.
METHODS: Articles published between 1 January 2000 and 10 November 2022 were identified via a PubMed search using combinations of the search terms \"spine surgery,\" \"ASD,\" \"complication,\" \"surgery,\" \"PJK,\" \"PJF,\" \"
tether,\" \"sublaminar band,\" and \"prophylaxis.\" No restrictions were placed on the number of patients, surgical indications, or surgical procedures. Relevant articles were reviewed and summarized.
RESULTS: Fifteen articles were identified, including 2 prospective cohorts (Level II), 10 retrospective cohorts (Level III), and 3 retrospective case series (Level IV). All studies were published between 2016 and 2022, and all focused on ASD patient populations. The mean age in each study ranged from 55 to 69 years, and most studies had a mean follow-up of at least 12 months (range, 5.5-45.4 months). Eleven studies used a polyethylene tether, 2 used soft sublaminar cables, and 2 used semitendinous allograft. The
tether extended to the UIV+1 or UIV+2, passing either through or around the spinous processes, in 13 studies. In the remaining 2 studies, the
tether was passed sublaminar at the UIV+1. Fourteen studies favored the use of tethers with regard to reduction of PJK/PJF rates, and one demonstrated similar rates of PJK between the tether and no-
tether groups.
CONCLUSIONS: PJK/PJF remain major challenges in ASD surgery. Most early studies suggest that the use of tethers for ligamentous augmentation may help to mitigate the development of PJK/PJF. However, the multifactorial etiology of PJK/PJF makes it unlikely that any single technique will solve this complex problem. Further study is needed to address not only the effectiveness of junctional tethers but also to clarify whether there are optimal tether configurations,
tether materials, and
tether tension.
METHODS: 3.