Guler Umit Ozgur, Cetin Engin, Yaman Onur, Pellise Ferran, Casademut Alba Villa, Sabat Montse Domingo, Alanay Ahmet, Grueso Francesco Sanchez Perez, Acaroglu Emre
Ankara Spine Center, Iran Caddesi 45/2 Kavaklidere, Ankara, 06800, Turkey.
Eur Spine J. 2015 May;24(5):1085-91. doi: 10.1007/s00586-014-3615-1. Epub 2014 Oct 17.
Sacropelvic fixation (SPF) is an integral part of ASD surgery. Literature suggests that combination of S1 and iliac screws may be associated with lowest rate of complications.
To analyze the rate and potential factors of mechanical failure associated with SPF in adult spinal deformity surgery.
Of 504 patients enrolled in a prospective multicentric database, 239 were treated conservatively and 265 were treated surgically. Forty-five of those who had sacroiliac fixations and with >6 months (or to failure) f/up constitute the population. Type of iliac fixation was S2 alar/iliac (S2AI) screws in 20 (44.4%) and iliac screws with lateral connectors (IwL) in 25 (55.6%). Diagnoses were degenerative in 20, failed back in 11 and other in 14. Average instrumentation length was 11.6 ± 4.0 levels. Cases with failure were compared to those without using Fisher's Exact and Mann-Whitney U tests.
A total of 16 implant related complications were identified (35.6%). Failures were identified on an average of 224.1 days (8-709) following index surgery. Failure rate of S2AI screws was 35 vs. 12% for IwL screws (p > 0.05). All broken screws were associated with S2AI technique with polyaxial screws. Comparison of failed cases to others revealed that failed cases had inadequate restoration of Lumbar Lordosis but this was not statistically insignificant. Only age was a significantly different, patient with failure being older.
Pelvic fixation is still associated with a very high rate of mechanical failure. Major risk factors appear to be age and type of fixation. Although could not be shown to be statistically significant, failure to restore the optimal sagittal balance may be a contributing factor as well. So in conclusion, in cases with suboptimal sagittal plane correction, S2AI with polyaxial screws seem to have higher risk of short-term acute failure compared to IwL.
骶骨盆固定术（SPF）是成人脊柱畸形手术不可或缺的一部分。文献表明，S1螺钉和髂骨螺钉联合使用可能与最低的并发症发生率相关。
分析成人脊柱畸形手术中与骶骨盆固定术相关的机械性故障发生率及潜在因素。
在一个前瞻性多中心数据库登记的504例患者中，239例接受保守治疗，265例接受手术治疗。其中45例行骶髂固定术且随访时间超过6个月（或直至失败）的患者构成研究人群。髂骨固定类型为S2翼/髂骨（S2AI）螺钉的有20例（44.4%），带外侧连接器的髂骨螺钉（IwL）有25例（55.6%）。诊断为退变性疾病的20例，腰椎术后失败综合征的11例，其他疾病的14例。平均内固定节段长度为11.6±4.0个节段。将发生故障的病例与未发生故障的病例进行比较，采用Fisher精确检验和Mann-Whitney U检验。
共发现16例与植入物相关的并发症（35.6%）。在初次手术后平均224.1天（8至709天）发现故障。S2AI螺钉的故障率为35%，而IwL螺钉为12%（p>0.05）。所有断裂螺钉均与使用多轴螺钉的S2AI技术相关。将发生故障的病例与其他病例进行比较发现，发生故障的病例腰椎前凸恢复不足，但这在统计学上无显著意义。只有年龄有显著差异，发生故障的患者年龄较大。
骨盆固定术仍然与非常高的机械性故障率相关。主要风险因素似乎是年龄和固定类型。尽管未能显示出统计学意义，但未能恢复最佳矢状面平衡可能也是一个促成因素。因此，综上所述，在矢状面矫正欠佳的病例中，与IwL相比，使用多轴螺钉的S2AI似乎有更高的短期急性失败风险。
