Department of Orthopedics, University of Colorado, Anschutz Medical Campus, 1365 N. Aurora Court, Aurora, CO, USA.
School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
Eur Spine J. 2020 Jun;29(6):1287-1296. doi: 10.1007/s00586-020-06291-0. Epub 2020 Jan 14.
This is a retrospective, single-institution, cohort study.
To evaluate the association of Mersilene tape use and risk of proximal junctional kyphosis (PJK), after surgical correction of adult spinal deformity (ASD) by posterior instrumented fusion (PIF). PJK, following long spinal PIF, is a complication which often requires reoperation. Mersilene tape, strap stabilization of the supra-adjacent level to upper instrumented vertebra (UIV) seems a preventive measure.
Patients who underwent PIF for ASD with Mersilene tape stabilization (case group) or without (control group) between 2006 and 2016 were analyzed preoperatively to 2-year follow-up. Matching of potential controls to each case was performed. Radiographic sagittal Cobb angle (SCA), lumbar lordosis, pelvic tilt, sacral slope, and pelvic incidence were measured pre- and postoperatively, using a deformity measuring software program. PJK was defined as progression of postoperative junctional SCA at UIV ≥ 10°.
Eighty patients were included: 20 cases and 60 controls. The cumulative rate of PJK ≥ 10° at 2-year follow-up was 15% in cases versus 38% of controls (OR = 0.28; P = 0.04) with higher latent period in cases, (20 vs. 7.5 months), P = 0.018. Mersilene tape decreased risk of PJK linked with the impact of the following confounders: age, ≥ 55 years old (OR = 0.19; 0.02 ≥ P ≤ 0.03); number of spinal levels fused 7-15 (OR = 0.13; 0.02 ≥ P ≤ 0.06); thoracic UIV (T12-T1) (OR = 0.13; 0.02 ≥ P ≤ 0.06); BMI ≥ 27 kg/m (OR = 0.22; 0.03 ≥ P ≤ 0.08); and osteoporosis (OR = 0.13; 0.02 ≥ P ≤ 0.08).
Mersilene tape at UIV + 1 level decreases the risk of PJK following PIF for ASD. These slides can be retrieved under Electronic Supplementary Material.
这是一项回顾性、单机构、队列研究。
评估后路器械固定融合（PIF）治疗成人脊柱畸形（ASD）后，Mersilene 带的使用与近端交界性后凸（PJK）风险的相关性。后路长节段固定融合后，PJK 是一种常见的并发症，常需再次手术治疗。Mersilene 带，即上固定椎（UIV）上方相邻节段的带固定，似乎是一种预防措施。
分析 2006 年至 2016 年间行 PIF 治疗 ASD 且使用 Mersilene 带稳定（病例组）或未使用（对照组）的患者，随访至术后 2 年。对每个病例进行潜在对照组的匹配。使用畸形测量软件程序测量术前和术后的矢状 Cobb 角（SCA）、腰椎前凸、骨盆倾斜、骶骨倾斜和骨盆入射角。PJK 定义为 UIV 处术后交界 SCA 进展≥10°。
共纳入 80 例患者：20 例病例和 60 例对照。2 年随访时 PJK≥10°的累积发生率为病例组 15%，对照组 38%（OR=0.28；P=0.04），且病例组潜伏期更长（20 个月 vs. 7.5 个月），P=0.018。Mersilene 带降低了 PJK 的风险，与以下混杂因素有关：年龄≥55 岁（OR=0.19；0.02≥P≤0.03）；融合节段 7-15 个（OR=0.13；0.02≥P≤0.06）；胸椎 UIV（T12-T1）（OR=0.13；0.02≥P≤0.06）；BMI≥27kg/m2（OR=0.22；0.03≥P≤0.08）；骨质疏松症（OR=0.13；0.02≥P≤0.08）。
后路 ASD 融合术中 UIV+1 水平使用 Mersilene 带可降低 PJK 风险。这些幻灯片可以在电子补充材料中检索到。
