Birkenmaier C
Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Klinikum der Universität München, Marchioninistr. 15, 81377, München, Deutschland.
Orthopade. 2018 Apr;47(4):310-319. doi: 10.1007/s00132-018-3537-4.
There are numerous factors that can lead to construct failure and pseudarthrosis after corrective pedicle subtraction osteotomy (PSO) in the lumbar spine. Frequently, several factors are of relevance in these problematic cases. This article attempts to explain the surgical, biomechanical and biological aspects that should be understood in order to minimize the risk of pseudarthrosis and construct failure. It addresses technical varieties of the PSO procedure as well as the surgical technique, the choice of rod material and the design of multirod constructs. Biological reasons for pseudarthrosis and preventive strategies are discussed, as well as the possible contribution of low-grade infections to pseudarthrosis. The option of substituting a multilevel ALIF procedure for a PSO is another topic, as is the question of surgical indication and strategy.
腰椎椎体后缘皮质切除术（PSO）矫形术后，有许多因素可导致内固定失败和假关节形成。在这些复杂病例中，通常有多个因素与之相关。本文旨在阐述一些手术、生物力学和生物学方面的要点，以便理解如何将假关节形成和内固定失败的风险降至最低。文章讨论了PSO手术的技术变化、手术技巧、棒材的选择以及多棒固定结构的设计。文中还探讨了假关节形成的生物学原因及预防策略，以及低度感染对假关节形成的可能影响。用多节段前路腰椎椎间融合术（ALIF）替代PSO手术也是一个讨论话题，手术指征和策略问题同样如此。
