使用髂骨螺钉进行长节段融合治疗成人脊柱畸形后骨盆倾斜度矫正丢失：对临床结果的影响及原因。
Loss of Pelvic Incidence Correction After Long Fusion Using Iliac Screws for Adult Spinal Deformity: Cause and Effect on Clinical Outcome.
机构信息
Department of Orthopaedic Surgery, Yamanashi University School of Medicine, Yamanashi.
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Nagano, Japan.
出版信息
Spine (Phila Pa 1976). 2019 Feb 1;44(3):195-202. doi: 10.1097/BRS.0000000000002775.
STUDY DESIGN
Retrospective observational cohort study.
OBJECTIVE
To determine change in pelvic incidence (PI) and loss of correction after long fusion with iliac screws, the effect of iliac screw loosening, and global alignment according to postoperative PI.
SUMMARY OF BACKGROUND DATA
Posterior long fixation and fusion of the thoracic to the ilium is one of the most common surgical treatments for adult spinal deformity (ASD). Long fusion to the sacrum with iliac screws decreases the PI by 3.9° after surgery. PI decreases once by long fusion with iliac screws. However, if the iliac screw loosens, PI may cause correction loss and return to the preoperative PI.
METHODS
We retrospectively reviewed the cases of 69 consecutive patients with ASD. Their mean age (SD) was 70.5 (7.3) years, 12% were male. PI was evaluated preoperatively, early- and 1-year postoperatively. We compared change in PI with and without loosening of iliac screws, spinopelvic parameters according to 1-year-postoperative PI.
RESULTS
PI decreased significantly from 51.8° (9.3°) to 48.1° (9.5°) early postoperatively (P < 0.01). PI increased significantly from 48.1° (9.5°) to 49.6° (9.7°) within a year postoperatively (P < 0.01). Significant loss of PI correction (2.3°, P < 0.01) occurred within a year after surgery in patients with iliac screw loosening and was significantly different from the PI loss in those without screw loosening (53.9°, 48.2°, P = 0.03). Pelvic tilt, sacral slope, C7 sagittal vertical axis, global tilt, and T1 pelvic angle were significantly smaller in the group with PI <50° postoperatively at 1 year compared with the group with PI >50°.
CONCLUSION
Although PI decreases after long fusion surgery with iliac screws, significant correction loss appears within a year. Loosening of iliac screws may exacerbate this loss. Patients with PI <50° postoperatively were able to maintain better global alignment.
LEVEL OF EVIDENCE
研究设计
回顾性观察队列研究。
目的
确定骨盆入射角（PI）的变化和髂骨螺钉后路长融合后矫正的丢失，以及根据术后 PI 评估髂骨螺钉松动的影响和整体排列。
背景资料概要
胸椎至髂骨的后路长固定和融合是成人脊柱畸形（ASD）最常见的手术治疗之一。用髂骨螺钉进行长融合可使术后 PI 降低 3.9°。PI 通过长融合用髂骨螺钉降低一次。然而，如果髂骨螺钉松动，PI 可能导致矫正丢失并恢复到术前 PI。
方法
我们回顾性分析了 69 例 ASD 连续患者的病例。其平均年龄（标准差）为 70.5（7.3）岁，12%为男性。术前、术后早期和 1 年评估 PI。我们比较了有和无髂骨螺钉松动的 PI 变化，并根据术后 1 年的 PI 比较了脊柱骨盆参数。
结果
PI 从术前的 51.8°（9.3°）显著降低到术后早期的 48.1°（9.5°）（P＜0.01）。PI 在术后 1 年内从 48.1°（9.5°）显著增加到 49.6°（9.7°）（P＜0.01）。在有髂骨螺钉松动的患者中，术后 1 年内出现明显的 PI 矫正丢失（2.3°，P＜0.01），与无螺钉松动的患者相比有显著差异（53.9°，48.2°，P=0.03）。术后 1 年，PI＜50°的患者骨盆倾斜度、骶骨倾斜度、C7 矢状垂直轴、整体倾斜度和 T1 骨盆角明显小于 PI＞50°的患者。
结论
尽管用髂骨螺钉进行后路长融合术后 PI 降低，但在 1 年内会出现明显的矫正丢失。髂骨螺钉松动可能会加剧这种丢失。术后 PI＜50°的患者能够保持更好的整体排列。
证据水平
3。
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