Ji Xinran, Chen Hua, Zhang Yiling, Zhang Lihai, Zhang Wei, Berven Sigurd, Tang Peifu
Department of Orthopaedic Surgery, The General Hospital of People's Liberation Army (301 Hospital), 28 Fuxing Road, Wukesong, Beijing, 100000, China.
Department of Orthopaedic Surgery, Medical Center, University of California, San Francisco, 500 Parnassus Ave., MU320W, San Francisco, CA, 94143-0728, USA.
J Orthop Surg Res. 2015 Feb 3;10:23. doi: 10.1186/s13018-015-0154-3.
The aim of this study was to analyze and compare the surgical data, clinical outcomes, and complications between three-column osteotomy (3-COS) and standard surgical management (SSM) for the treatment of adult spine deformity (ASD).
A total of 112 patients who underwent consecutive 3-COS (n = 48) and SSM (n = 64) procedures for ASD correction at a single institution from 2001 to 2011 were reviewed in this study. The outcomes were assessed using the Scoliosis Research Society (SRS)-22 scores. The complications of patients with 3-COS and SSM were also compared.
No significant differences were found in patient characteristics between SSM and 3-COS groups. Surgical data and radiographic parameters showed that the patients of the 3-COS group suffered more severe ASD than those of the SSM group. The distribution of surgical complications revealed that SSM group underwent more complications than 3-COS groups with no significant differences. At final follow-up, the total SRS-22 score of SSM was not significant between pre-operation and post-operation. However, the total SRS-22 score of 3-COS at final follow-up was significantly higher than pre-operation.
For severe ASD patients with high grade pelvic incidence (PI), pelvic tilt (PT), and PI/lumbar lordosis (LL) mismatch and who have subjected to spine surgeries more than twice before, 3-COS might be more effective than SSM in improving the clinical outcomes. However, due to the higher reoperation rate of 3-COS, SSM may be more appropriate than SSM for correcting the not serious ASD patients.
本研究旨在分析和比较三柱截骨术（3-COS）与标准手术治疗（SSM）在治疗成人脊柱畸形（ASD）方面的手术数据、临床结果和并发症。
本研究回顾了2001年至2011年在单一机构连续接受3-COS（n = 48）和SSM（n = 64）手术矫正ASD的112例患者。使用脊柱侧弯研究学会（SRS）-22评分评估结果。还比较了3-COS和SSM患者的并发症。
SSM组和3-COS组患者特征无显著差异。手术数据和影像学参数显示，3-COS组患者的ASD比SSM组更严重。手术并发症分布显示，SSM组的并发症比3-COS组多，但无显著差异。在末次随访时，SSM术前和术后的SRS-22总分无显著差异。然而，3-COS末次随访时的SRS-22总分显著高于术前。
对于骨盆倾斜度（PI）、骨盆倾斜（PT）和PI/腰椎前凸（LL）不匹配程度高且既往接受过两次以上脊柱手术的重度ASD患者，3-COS在改善临床结果方面可能比SSM更有效。然而，由于3-COS的再手术率较高，对于矫正不太严重的ASD患者，SSM可能比3-COS更合适。
