Okada Eijiro, Shiono Yuta, Nishida Mitsuhiro, Mima Yuichiro, Funao Haruki, Shimizu Kentaro, Kato Masanori, Fukuda Kentaro, Fujita Nobuyuki, Yagi Mitsuru, Nagoshi Narihito, Tsuji Osahiko, Ishii Ken, Nakamura Masaya, Matsumoto Morio, Watanabe Kota
1 Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
2 Keio Spine Research Group, Tokyo, Japan.
J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019843407. doi: 10.1177/2309499019843407.
To validate the effectiveness of percutaneous pedicle screw (PPS) fixation for spinal fractures associated with diffuse idiopathic skeletal hyperostosis (DISH) by comparing surgical outcomes for PPS fixation and conventional open posterior fixation. Patients with DISH are vulnerable to unstable spinal fractures caused by trivial trauma, and these fractures have high rates of delayed paralysis, postoperative complications, and mortality.
This retrospective study assessed surgical outcomes for 16 patients with DISH (12 men; mean age 76.1 ± 9.4 years) who underwent PPS fixation for spinal fractures (pedicle screw (PS) group), and for a control group of 25 patients with DISH (18 men; mean age 77.9 ± 9.9 years) who underwent conventional open fixation (O group) at our affiliated hospitals from 2007 to 2017. We evaluated the preoperative physical condition (American Society of Anesthesiologists (ASA) classification), neurological status (Frankel grade), and improvement after surgery, fusion length, operating time, estimated blood loss, and perioperative complications.
Preoperatively, the PS group consisted of one ASA-1 patient, eight ASA-2 patients, six ASA-3 patients, and one ASA-4 patient; by Frankel grade, there were 2 grade B patients, 13 grade C, 4 grade D, and 6 grade E patients. The O group had 2 ASA-1 patients, 13 ASA-2, 9 ASA-3, and 1 ASA-4 patients. Frankel grades in the O group reflected severe neurological deficits, with 3 grade C patients, 2 grade D, and 11 grade E ( p = 0.032) patients. The two groups had similar rates of neurological improvement (33.3% of PS and 40.0% of O patients; p = 0.410) and mean fusion length (PS 5.1 ± 0.8 segments; O 4.9 ± 1.2). The mean operating time and estimated blood loss were 168.1 ± 46.7 min and 133.9 ± 116.5 g, respectively, in the PS group, and 224.6 ± 49.8 min and 499.9 ± 368.5 g in the O group. Three O-group patients died of hypovolemic shock, respiratory failure, and pneumonia, respectively, within a year of surgery.
Conventional open posterior fixation and PPS fixation for DISH-related spinal fractures were similar in fusion length and neurological improvement. However, PPS fixation was less invasive and had lower complication rates.
通过比较经皮椎弓根螺钉（PPS）固定与传统开放性后路固定治疗弥漫性特发性骨肥厚（DISH）相关脊柱骨折的手术效果，验证PPS固定的有效性。DISH患者易因轻微创伤发生不稳定脊柱骨折，且这些骨折的延迟性瘫痪、术后并发症及死亡率较高。
这项回顾性研究评估了2007年至2017年在我们附属医院接受脊柱骨折PPS固定的16例DISH患者（12例男性；平均年龄76.1±9.4岁）（椎弓根螺钉（PS）组）以及25例接受传统开放性固定的DISH对照组患者（18例男性；平均年龄77.9±9.9岁）（O组）的手术效果。我们评估了术前身体状况（美国麻醉医师协会（ASA）分级）、神经状态（Frankel分级）、术后改善情况、融合长度、手术时间、估计失血量及围手术期并发症。
术前，PS组包括1例ASA-1级患者、8例ASA-2级患者、6例ASA-3级患者和1例ASA-4级患者；按Frankel分级，有2例B级患者、13例C级、4例D级和6例E级患者。O组有2例ASA-1级患者、13例ASA-2级、9例ASA-3级和1例ASA-4级患者。O组的Frankel分级反映出严重神经功能缺损，有3例C级患者、2例D级和11例E级（p = 0.032）患者。两组神经功能改善率相似（PS组为33.3%，O组为40.0%；p = 0.410），平均融合长度也相似（PS组为5.1±0.8节段；O组为4.9±1.2节段）。PS组平均手术时间和估计失血量分别为168.1±46.7分钟和133.9±116.5克，O组分别为224.6±49.8分钟和499.9±368.5克。O组有3例患者分别在术后1年内死于低血容量性休克、呼吸衰竭和肺炎。
对于DISH相关脊柱骨折，传统开放性后路固定和PPS固定在融合长度和神经功能改善方面相似。然而，PPS固定的创伤较小且并发症发生率较低。
