Hyun Seung-Jae, Lenke Lawrence G, Kim Yong Chan, Koester Linda A, Blanke Kathy M
*Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO; and †Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea; ‡Spine Center, Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anyang, Gyeonggi-do, Republic of Korea.
Spine (Phila Pa 1976). 2015 Apr 1;40(7):E428-32. doi: 10.1097/BRS.0000000000000783.
Retrospective study.
To evaluate long-term effectiveness of central hook-rod constructs for posterior spinal osteotomy closure.
During osteotomy site closure various techniques are used, including patient positioning, rod cantilevering, extending fixation points, and compressing through pedicle fixation points. All add premature stress on fixation points and may lead to loosening/eventual fixation failure. To avoid this, we often use a central compression hook-rod construct for osteotomy closure.
Fifty-six consecutive patients with fixed sagittal imbalance were treated with multilevel posterior column osteotomies (N = 19), pedicle subtraction osteotomy (N = 31), or vertebral column resection (N = 6). All 56 patients had undergone osteotomy closure using central compression hook-rod constructs and were analyzed at a follow-up of 5 years or more. Compression hooks were inserted into the fusion mass or lamina above/below the osteotomy and centrally attached to a short rod connected to pedicle screw-based rods via a cross-link. Diagnoses included sagittal imbalance associated with scoliosis (N = 39), degenerative sagittal imbalance (N = 14), ankylosing spondylitis (N = 2), and Scheuermann's kyphosis (N = 1). There were 55 revision cases and 1 primary. Radiographic/clinical analysis was performed to evaluate the efficacy/complications of this technique.
Overall lumbar lordosis increased an average of 31.7° and local lordosis through the osteotomy site increased an average of 29.3°. Sagittal balance improved by an average of 92 mm. In all cases, osteotomy closures were performed without screw loosening or loss of correction intraoperatively. At a follow-up of 5 years or more, no failures of the hook-rod construct were seen, but there were 3 patients with partial implant failure; however, no symptomatic pseudarthroses at the osteotomy sites occurred. Seven patients developed pseudarthrosis below the central hook-rod construct.
A central hook-rod construct is safe, controlled, and effective for applying compressive forces to close various spinal osteotomies without fixation failure or pseudarthrosis at the osteotomy site noted at a follow-up of 5 or more years. It adds fixation strength to the overall construct avoiding undue stress on pedicle screws.
回顾性研究。
评估中央钩棒结构用于后路脊柱截骨闭合的长期有效性。
在截骨部位闭合过程中，会采用多种技术，包括患者体位摆放、棒的悬臂操作、延长固定点以及通过椎弓根固定点进行加压。所有这些都会给固定点增加过早的应力，并可能导致松动/最终固定失败。为避免这种情况，我们经常使用中央加压钩棒结构进行截骨闭合。
连续56例固定性矢状面失衡患者接受了多级后柱截骨术（n = 19）、椎弓根截骨术（n = 31）或脊柱切除术（n = 6）。所有56例患者均使用中央加压钩棒结构进行了截骨闭合，并在5年或更长时间的随访中进行了分析。将加压钩插入截骨上方/下方的融合块或椎板中，并在中央连接到一根短棒，该短棒通过一个横向连接件与基于椎弓根螺钉的棒相连。诊断包括与脊柱侧弯相关的矢状面失衡（n = 39）、退行性矢状面失衡（n = 14）、强直性脊柱炎（n = 2）和休门氏驼背（n = 1）。有55例翻修病例和1例初次手术病例。进行了影像学/临床分析以评估该技术的疗效/并发症。
总体腰椎前凸平均增加31.7°，通过截骨部位的局部前凸平均增加29.3°。矢状面平衡平均改善92毫米。在所有病例中，术中截骨闭合均未出现螺钉松动或矫正丢失。在5年或更长时间的随访中，未观察到钩棒结构失败，但有3例患者出现部分植入物失败；然而，截骨部位未出现有症状的假关节形成。7例患者在中央钩棒结构下方出现假关节形成。
中央钩棒结构在应用压缩力闭合各种脊柱截骨时是安全、可控且有效的，在5年或更长时间的随访中未发现截骨部位固定失败或假关节形成。它增加了整体结构的固定强度，避免了椎弓根螺钉承受过度应力。
3级。
