Kim Yongjung J, Bridwell Keith H, Lenke Lawrence G, Cho Kyu-Jung, Edwards Charles C, Rinella Anthony S
Washington University Medical Center, St. Louis, MO, USA.
J Bone Joint Surg Am. 2006 Apr;88(4):721-8. doi: 10.2106/JBJS.E.00550.
There have been few detailed reports concerning pseudarthrosis following spinal instrumentation and arthrodesis in adults with spinal deformity since the introduction of modern segmental fixation techniques. The purposes of this study were to analyze the prevalence, risk factors, and outcome scores on the Scoliosis Research Society Instrument-24 associated with pseudarthrosis following instrumentation and arthrodesis for the treatment of spinal deformity in adults.
A clinical and radiographic assessment of 232 adults with spinal deformity who were treated surgically at a single institution was conducted. The average age of the patients was 40.8 years, and the operation was a primary procedure in 150 patients and a revision procedure in eighty-two patients. All patients who underwent a long (four vertebrae or more) spinal instrumentation and arthrodesis with a minimum follow-up of two years were included in the analysis. Clinical outcomes were assessed with the Scoliosis Research Society questionnaire.
Forty patients had a pseudarthrosis. Factors that were found to be significantly associated with pseudarthrosis were preoperative thoracolumbar kyphosis of >20 degrees (p < 0.0001), an age of more than fifty-five years (p = 0.001), arthrodesis to S1 compared with arthrodesis to L5 or a cephalad level (p = 0.002), and arthrodesis of more than twelve vertebrae (p = 0.037). Patients with a pseudarthrosis had lower total outcome scores on the Scoliosis Research Society questionnaire, on the average, than those without a pseudarthrosis (p = 0.001).
The prevalence of pseudarthrosis following long arthrodesis with use of modern segmental spinal instrumentation for the treatment of spinal deformity in adults was 17%, and the clinical outcome in these patients can be negatively affected by the pseudarthrosis.
自从现代节段性固定技术引入以来，关于成人脊柱畸形患者脊柱内固定及融合术后假关节形成的详细报道较少。本研究的目的是分析成人脊柱畸形患者行内固定及融合术后假关节形成的发生率、危险因素以及与脊柱侧凸研究学会24项量表（Scoliosis Research Society Instrument-24，SRS-24）相关的疗效评分。
对在单一机构接受手术治疗的232例成人脊柱畸形患者进行了临床和影像学评估。患者的平均年龄为40.8岁，其中150例患者接受的是初次手术，82例患者接受的是翻修手术。所有接受长节段（四个或更多椎体）脊柱内固定及融合且至少随访两年的患者均纳入分析。采用脊柱侧凸研究学会问卷评估临床疗效。
40例患者发生了假关节形成。发现与假关节形成显著相关的因素包括术前胸腰段后凸>20度（p<0.0001）、年龄超过55岁（p=0.001）、融合至S1与融合至L5或更高节段相比（p=0.002）以及融合超过12个椎体（p=0.037）。假关节形成患者在脊柱侧凸研究学会问卷上的总疗效评分平均低于无假关节形成的患者（p=0.001）。
成人脊柱畸形患者采用现代节段性脊柱内固定进行长节段融合术后假关节形成的发生率为17%，假关节形成会对这些患者的临床疗效产生负面影响。
