Boachie-Adjei Oheneba, Ferguson John A I, Pigeon Richard G, Peskin Melissa R
Scoliosis Service, Hospital for Special Surgery, Cornell University Medical School, USA.
Spine (Phila Pa 1976). 2006 Feb 15;31(4):485-92. doi: 10.1097/01.brs.0000199893.71141.59.
A retrospective consecutive case series, radiographic analysis, outcomes analysis, and report on complications.
To evaluate the radiographic and functional outcomes of a reconstructive realignment procedure for fixed sagittal imbalance and discuss the complications.
We describe a modification of an existing technique permitting greater single-level correction for which no reports exist in the peer-reviewed literature.
Twenty-four patients were eligible for 2-year minimum follow-up (average, 4.0 years). Etiologies included iatrogenic (n = 17), post-traumatic (n = 3), ankylosing spondylitis (n = 2), degenerative (n = 1), and congenital (n = 1). Patients were evaluated by standardized upright radiographs, chart review, and National Spine Network questionnaire.
Seventeen patients had undergone 17 previous procedures. Seven of 24 patients required augmentation with anterior structural grafting. The majority of osteotomies were performed at L3 (15); others included L2 (6), L4 (2), and L5 (1). Lumbar lordosis before surgery averaged 13 degrees (range, 55 degrees to -65 degrees) and improved to 53 degrees (range, 20 degrees to 99 degrees), an average correction of 40%. The sagittal vertical axis measured from C7-S1 demonstrated a preoperative sagittal decompensation averaging 11.4 cm (range, 5.5-23 cm) with correction to 2.4 cm (-9.0 cm or 79% average correction). Coronal balance did not change significantly. There were 17 complications in 14 patients. Nine patients required additional surgery at latest follow-up.
Transpedicular wedge resection osteotomy procedure is a very effective technique to correct fixed sagittal imbalance and provide biomechanical stability. The high complication rate mandates a careful assessment of the risk/benefit ratio before undertaking what is a major reconstructive procedure. Most patients are satisfied, particularly when sagittal balance is achieved.
一项回顾性连续病例系列研究，包括影像学分析、结果分析及并发症报告。
评估针对固定矢状面失衡的重建性重新排列手术的影像学及功能结果，并探讨并发症情况。
我们描述了一种对现有技术的改良方法，该方法可实现更大程度的单节段矫正，而同行评审文献中尚无相关报道。
24例患者符合至少随访2年的条件（平均随访4.0年）。病因包括医源性（n = 17）、创伤后（n = 3）、强直性脊柱炎（n = 2）、退行性病变（n = 1）及先天性（n = 1）。通过标准化站立位X线片、病历回顾及国家脊柱网络问卷对患者进行评估。
17例患者此前接受过17次手术。24例患者中有7例需要前路结构性植骨进行强化。大多数截骨术在L3节段进行（15例）；其他节段包括L2（6例）、L4（2例）和L5（1例）。术前腰椎前凸平均为13度（范围为55度至 -65度），术后改善至53度（范围为20度至99度），平均矫正40%。从C7 - S1测量的矢状垂直轴显示，术前矢状面失代偿平均为11.4厘米（范围为5.5 - 23厘米），矫正后为2.4厘米（-9.0厘米或平均矫正79%）。冠状面平衡无显著变化。14例患者出现17例并发症。9例患者在最近一次随访时需要再次手术。
经椎弓根楔形切除截骨术是矫正固定矢状面失衡并提供生物力学稳定性的一种非常有效的技术。高并发症发生率要求在进行这一主要重建手术前仔细评估风险/获益比。大多数患者感到满意，尤其是在实现矢状面平衡时。
