Jentzsch Thorsten, Gomes de Lima Vinicius, Seifert Burkhardt, Sprengel Kai, Werner Clément M L
Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Eur Spine J. 2016 Mar;25(3):856-64. doi: 10.1007/s00586-015-4211-8. Epub 2015 Sep 4.
While spinal instrumentations are becoming more common, the advantages of elective spinal implant removal remain ambiguous. We hypothesized that elective implant removal of the posterior spine is beneficial.
A retrospective study evaluated 137 consecutive trauma patients with elective implant removal of the posterior spine. If additional cages were present, they were not removed. Primary outcomes were the change in pre- and post-operative pain, fingertip-floor distance (FFD), and Cobb angles. Some secondary outcomes consisted of complications, work disability, and pelvic incidence (PI). Different stabilization approaches and cage sizes were compared.
The presence and amount of pain as well as the FFD showed significant improvement. There was no loss of reduction. Delayed wound healing was observed in 9%, but only 3% needed revision. Thoracic fascial dehiscences were seen only in patients (9%) that had stand-alone posterior surgery. Larger cages were associated with increased work disability. An increased PI was associated with less post-operative pain and decreased FFD.
In this study, trauma patients benefited from elective implant removal of the posterior spine due to lower presence and level of pain, improved function and low revision rates; irrespective of an initial combined or stand-alone posterior approach or varying cage sizes. However, stand-alone posterior instrumentation may be accompanied by increased rates of fascial dehiscence surgeries and larger cages may lead to increased work disability. Increased PI may be associated with less pain after spinal implant removal.
虽然脊柱内固定术越来越普遍，但选择性脊柱植入物取出的优势仍不明确。我们假设选择性后路脊柱植入物取出是有益的。
一项回顾性研究评估了137例连续接受选择性后路脊柱植入物取出术的创伤患者。如果存在额外的椎间融合器，则不取出。主要结局指标为术前和术后疼痛、指尖距地面距离（FFD）和Cobb角的变化。一些次要结局指标包括并发症、工作能力丧失和骨盆入射角（PI）。比较了不同的固定方法和椎间融合器尺寸。
疼痛的程度和FFD均有显著改善。复位无丢失。9%的患者出现伤口愈合延迟，但仅3%的患者需要翻修。仅在接受单纯后路手术的患者（9%）中观察到胸段筋膜裂开。较大的椎间融合器与工作能力丧失增加有关。PI增加与术后疼痛减轻和FFD降低有关。
在本研究中，创伤患者因疼痛程度降低、功能改善和翻修率低而从选择性后路脊柱植入物取出术中获益；无论最初采用的是联合还是单纯后路手术方式，也无论椎间融合器尺寸如何。然而，单纯后路内固定术可能伴随着筋膜裂开手术发生率的增加，且较大的椎间融合器可能导致工作能力丧失增加。PI增加可能与脊柱植入物取出术后疼痛减轻有关。
