先前截骨部位或其他部位发生假关节导致固定矢状面失衡的椎弓根截骨术后翻修手术结果：翻修后至少5年。
Results of revision surgery after pedicle subtraction osteotomy for fixed sagittal imbalance with pseudarthrosis at the prior osteotomy site or elsewhere: minimum 5 years post-revision.
作者信息
Kim Yong-Chan, Lenke Lawrence G, Hyun Seung-Jae, Lee Jae-Hoo, Koester Linda A, Blanke Kathy M
机构信息
*Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO †Department of Orthopaedic Surgery, Spine Center, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Gyeonggi-do, Republic of Korea; and ‡Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
出版信息
Spine (Phila Pa 1976). 2014 Oct 1;39(21):1817-28. doi: 10.1097/BRS.0000000000000526.
STUDY DESIGN
Retrospective review of pedicle subtraction osteotomy (PSO) cases.
OBJECTIVE
To report our results, radiographic and clinical outcomes at a minimum 5 years following revision surgery for pseudarthrosis after a PSO.
SUMMARY OF BACKGROUND DATA
To our knowledge, there is no report on the results of revision surgery for pseudarthrosis after a PSO.
METHODS
Eighteen consecutive patients with pseudarthrosis after PSO (16 females/2 males; average age at surgery, 49.8 yr) treated with revision surgery at one institution were analyzed (average follow-up, 6.5 yr; range, 5-12 yr). Radiographic and clinical outcomes analysis was performed.
RESULTS
Sagittal vertical axis (SVA) and lumbar lordosis (LL) improved significantly after revision surgery (SVA, P = 0.000; LL, P = 0.024) and were maintained until ultimate post-revision follow-up (SVA, P = 0.170; LL, P = 0.729). Proximal junctional angle (P = 0.828), thoracic kyphosis (P = 0.828), and PSO angle (P = 0.717) achieved by the primary surgery were also maintained until ultimate post-revision. We increased the number of rods and/or changed them to 6.35-mm diameter in all patients. There were significant improvements post-revision in Oswestry Disability Index (45 vs. 37.9, P = 0.041) and Scoliosis Research Society pain subscale (2.6 vs. 3.1, P = 0.047) but not in Scoliosis Research Society total score or other subscales. Pelvic incidence greater than 60° demonstrated a trend toward poorer Oswestry Disability Index and Scoliosis Research Society scores (P > 0.05), but there were no significant differences between SVA greater or less than 11 cm.
CONCLUSION
Revision surgery for pseudarthrosis after PSO can provide acceptable radiographic and clinical outcomes at a minimum 5 years post-revision. Successful surgical outcomes may be achieved by using an increased number or size of implants and ample bone graft for complete fusion after revision surgery.
LEVEL OF EVIDENCE
研究设计
对椎弓根截骨术（PSO）病例进行回顾性研究。
目的
报告PSO术后假关节翻修手术至少5年后的结果、影像学和临床结局。
背景资料总结
据我们所知，尚无关于PSO术后假关节翻修手术结果的报告。
方法
分析在同一机构接受翻修手术的18例连续PSO术后假关节患者（16例女性/2例男性；手术平均年龄49.8岁）（平均随访6.5年；范围5 - 12年）。进行影像学和临床结局分析。
结果
翻修手术后矢状垂直轴（SVA）和腰椎前凸（LL）显著改善（SVA，P = 0.000；LL，P = 0.024），并维持至翻修术后最终随访（SVA，P = 0.170；LL，P = 0.729）。初次手术获得的近端交界角（P = 0.828）、胸椎后凸（P = 0.828）和PSO角（P = 0.717）也维持至翻修术后最终随访。我们在所有患者中增加了棒的数量和/或将其更换为直径6.35毫米的棒。翻修术后Oswestry功能障碍指数（45对37.9，P = 0.041）和脊柱侧凸研究学会疼痛亚量表（2.6对3.1，P = 0.047）有显著改善，但脊柱侧凸研究学会总分或其他亚量表无改善。骨盆入射角大于60°显示出Oswestry功能障碍指数和脊柱侧凸研究学会评分较差的趋势（P > 0.05），但SVA大于或小于11厘米之间无显著差异。
结论
PSO术后假关节翻修手术在翻修后至少5年可提供可接受的影像学和临床结局。翻修手术后使用增加数量或尺寸的植入物以及充足的骨移植以实现完全融合，可能获得成功的手术结局。
证据级别
4级。
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