Kim Han Jo, Boachie-Adjei Oheneba, Shaffrey Christopher I, Schwab Frank, Lafage Virginie, Bess Shay, Gupta Munish C, Smith Justin S, Deviren Vedat, Akbarnia Behrooz, Mundis Greg M, OʼBrien Michael, Hostin Richard, Ames Christopher
*Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY; †Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA; ‡Department of Orthopedic Surgery, New York University School of Medicine, New York, NY; §Rocky Mountain Hospital for Children, Presbyterian/St Luke's Medical Center, Denver, CO; ¶Department of Orthopedic Surgery, University of California Davis, Sacramento, CA; ‖Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA; **San Diego Center for Spinal Disorders, La Jolla, CA; ††Michael O'Brien, Baylor Scoliosis Center, Plano, TX; and ‡‡Department of Neurosurgery, University of California San Francisco, San Francisco, CA.
Spine (Phila Pa 1976). 2014 Jun 1;39(13):E795-9. doi: 10.1097/BRS.0000000000000339.
Retrospective review-multicenter database.
The purpose of this study was to compare the upper thoracic (UT) and lower thoracic (LT) upper instrumented vertebrae (UIV) in long fusions to the sacrum for adult scoliosis.
The optimal UIV for stopping long fusions to the sacrum/pelvis are controversial. Although a UT endpoint may lead to greater operative times, blood loss, and higher rates of pseudarthrosis, the risk for the development of proximal junctional kyphosis and need for revision surgery is likely lower.
Retrospective analysis of a prospective database of patients with adult spinal deformity, Patients were selected on the basis of fusions to the sacrum/pelvis with UIV of T1-T6 (UT group) and those with a UIV of T9-L1 (LT group). Demographic data, operative details, and radiographical outcomes with Scoliosis Research Society scores, and Oswestry Disability Index outcomes were collected, as well as complication data were compared. The Fisher exact T tests were used for statistical analysis.
A total of 198 patients (UT = 91, LT = 107) with a mean age of 61.6 were followed for an average of 2.5 years. Demographic variables were similar between the groups except for larger numbers of females in the UT group and a slightly higher body mass index in the LT group. Preoperatively, the UT group demonstrated significantly more lumbar scoliosis, thoracic scoliosis, and thoracolumbar kyphosis. The UT group demonstrated a larger number of fused segments length of stay and longer operative times. There was slightly larger volume of blood loss in the UT group.The total number of complications and number of revision surgical procedures were similar between the groups. The UT group had a higher percentage of patients with 2 or more complications. Both groups had similar proximal junctional kyphosis angles and number of cases requiring revision for proximal junctional kyphosis. Scoliosis Research Society and Oswestry Disability Index outcomes were similar between the groups.
The UT and LT groups had similar outcomes. The UT group may have a higher rate of total complications, but major complications requiring return to the operative room were similar. The length of stay and operative times were higher in the UT group but may have been necessarily evidenced by the significantly higher coronal deformity and greater thoracolumbar kyphosis in the UT group.
回顾性分析——多中心数据库。
本研究旨在比较成人脊柱侧凸长节段融合至骶骨时，上胸椎（UT）和下胸椎（LT）的上固定椎（UIV）情况。
长节段融合至骶骨/骨盆的最佳UIV存在争议。尽管以UT为终点可能会导致手术时间更长、失血更多以及假关节形成率更高，但近端交界性后凸畸形的发生风险以及翻修手术的需求可能更低。
对成人脊柱畸形患者的前瞻性数据库进行回顾性分析。根据融合至骶骨/骨盆且UIV为T1 - T6的患者（UT组）和UIV为T9 - L1的患者（LT组）进行选择。收集人口统计学数据、手术细节、采用脊柱侧凸研究学会评分的影像学结果以及奥斯维斯特里功能障碍指数结果，同时比较并发症数据。采用Fisher精确检验进行统计分析。
共198例患者（UT组91例，LT组107例），平均年龄61.6岁，平均随访2.5年。除UT组女性数量较多且LT组体重指数略高外，两组间人口统计学变量相似。术前，UT组腰椎侧凸、胸椎侧凸和胸腰段后凸畸形更明显。UT组融合节段数量更多、住院时间更长且手术时间更长。UT组失血量略多。两组间并发症总数和翻修手术例数相似。UT组有2种或更多并发症的患者比例更高。两组近端交界性后凸畸形角度以及因近端交界性后凸畸形需要翻修的病例数相似。两组间脊柱侧凸研究学会和奥斯维斯特里功能障碍指数结果相似。
UT组和LT组结果相似。UT组总并发症发生率可能更高，但需要返回手术室的主要并发症相似。UT组住院时间和手术时间更长，但这可能必然是由UT组明显更高的冠状面畸形和更大的胸腰段后凸畸形所导致。
4级。
