Daniels Alan H, DePasse J Mason, Durand Wesley, Hamilton D Kojo, Passias Peter, Kim Han Jo, Protopsaltis Themistocles, Reid Daniel B C, LaFage Virginie, Smith Justin S, Shaffrey Christopher, Gupta Munish, Klineberg Eric, Schwab Frank, Burton Doug, Bess Shay, Ames Christopher, Hart Robert A
Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Department of Orthopaedics, Division of Spine Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, USA.
World Neurosurg. 2018 Sep;117:e530-e537. doi: 10.1016/j.wneu.2018.06.071. Epub 2018 Jun 19.
Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated.
Patients with ASD in a multicenter database were assessed for radiographic fusion by a committee of 3 spinal deformity surgeons. Fusions were rated as bilaterally fused (A), unilaterally fused (B), partially fused (C), or not fused (D). Patients with grade A or B fusion and 2-year follow-up were included. Patients with radiographic fusion were evaluated for subsequent rod fracture. Adjusted analyses were conducted with multiple logistic regression, using backwards-variable selection to a threshold of P < 0.2, to assess for associated factors.
Of 402 patients with radiographically apparent solid fusion, 9.5% (38) subsequently suffered a broken rod. On multivariate analysis, greater rates of rod fracture were seen among patients of age group 60-69 years (vs. 18-49), body mass index 30-34 and 35+ (vs. <25), stainless-steel rods (vs. titanium), patients with rods ≤5.5 mm (vs. 6.35 mm), and patients with Charlson score 0 (vs. 3+). Of the 38 patients with rod fractures, 18 (47.4%) presented with worsened pain, and 8 (21.1%) required revision at minimum 2-year follow-up.
Rod fracture occurred in 9.5% of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1% required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.
成人脊柱畸形（ASD）手术后会发生棒体骨折，并伴有融合延迟或假关节形成。此前尚未对影像学上显示融合后出现的棒体骨折进行研究。
由3位脊柱畸形外科医生组成的委员会对多中心数据库中的ASD患者进行影像学融合评估。融合情况分为双侧融合（A）、单侧融合（B）、部分融合（C）或未融合（D）。纳入A或B级融合且有2年随访资料的患者。对影像学融合的患者评估其随后的棒体骨折情况。采用多因素逻辑回归进行校正分析，通过向后变量选择至P<0.2的阈值，以评估相关因素。
在402例影像学上显示牢固融合的患者中，9.5%（38例）随后发生棒体骨折。多因素分析显示，60 - 69岁年龄组患者（相对于18 - 49岁）、体重指数为30 - 34和35以上（相对于<25）、使用不锈钢棒（相对于钛棒）、棒体直径≤5.5 mm（相对于6.35 mm）以及Charlson评分为0的患者（相对于3分及以上）发生棒体骨折的比例更高。在38例棒体骨折患者中，18例（47.4%）出现疼痛加重，8例（21.1%）在至少2年随访时需要翻修手术。
ASD手术后，9.5%影像学上显示牢固融合的患者发生了棒体骨折。高龄、肥胖、小直径棒体（5.5 mm）、截骨术以及较低的合并症负担与棒体骨折显著相关。近一半的此类患者出现疼痛加重，21.1%需要翻修手术。即使在平片上显示明显融合的情况下，内固定失败仍可能发生且可能出现症状。
