Royal College of Surgeons in Ireland, Dublin, Ireland.
School of Medicine, Trinity College Dublin, Dublin, Ireland; National Spinal Injuries Unit, Department of Trauma & Orthopaedic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
Bone Joint J. 2020 Oct;102-B(10):1368-1374. doi: 10.1302/0301-620X.102B10.BJJ-2020-0273.R3.
Whether a combined anteroposterior fusion or a posterior-only fusion is more effective in the management of patients with Scheuermann's kyphosis remains controversial. The aim of this study was to compare the radiological and clinical outcomes of these surgical approaches, and to evaluate the postoperative complications with the hypothesis that proximal junctional kyphosis would be more common in one-stage posterior-only fusion.
A retrospective review of patients treated surgically for Scheuermann's kyphosis between 2006 and 2014 was performed. A total of 62 patients were identified, with 31 in each group. Parameters were compared to evaluate postoperative outcomes using chi-squared tests, independent-samples -tests, and z-tests of proportions analyses where applicable.
There were six postoperative infections in the two-stage anteroposterior group compared with three in the one-stage posterior-only group. A total of four patients in the anteroposterior group required revision surgery, compared with six in the posterior-only group. There was a significantly higher incidence of junctional failure associated with the one-stage posterior-only approach (12.9% vs 0%, p = 0.036). Proximal junction kyphosis (anteroposterior fusion (74.2%) vs posterior-only fusion (77.4%); p = 0.382) and distal junctional kyphosis (anteroposterior fusion (25.8%) vs posterior-only fusion (19.3%), p = 0.271) are common postoperative complications following both surgical approaches.
A two-stage anteroposterior fusion was associated with a significantly greater correction of the kyphosis compared with a one-stage posterior-only fusion, with a reduced incidence of junctional failure (0 vs 3). There was a notably greater incidence of infection with two-stage anteroposterior fusion; however, all were medically managed. More patients in the posterior-only group required revision surgery. Cite this article: 2020;102-B(10):1368-1374.
对于Scheuermann 脊柱后凸患者，前路-后路联合融合与单纯后路融合，哪种方法更有效，目前仍存在争议。本研究旨在比较这两种手术方法的影像学和临床结果，并评估术后并发症，假设一期后路单纯融合后会更常见近端交界性后凸。
对 2006 年至 2014 年接受手术治疗的 Scheuermann 脊柱后凸患者进行回顾性研究。共纳入 62 例患者，其中每组 31 例。通过卡方检验、独立样本 t 检验和 z 检验对术后参数进行比较，以评估术后结果。
两期前路-后路组术后感染 6 例，一期后路单纯融合组术后感染 3 例。前路-后路组共 4 例患者需要翻修手术，后路单纯融合组 6 例。一期后路单纯融合组近端交界性失败的发生率显著更高（12.9% vs 0%，p = 0.036）。后路单纯融合组（77.4%）与前路-后路组（74.2%）的近端交界性后凸（p = 0.382）和后路单纯融合组（19.3%）与前路-后路组（25.8%）的远端交界性后凸（p = 0.271）均为常见的术后并发症。
与一期后路单纯融合相比，两期前路-后路融合可显著改善脊柱后凸畸形的矫正程度，且交界性失败发生率降低（0% vs 3%）。两期前路-后路融合术后感染发生率显著更高；但所有感染均经药物治疗得以控制。后路单纯融合组中更多患者需要接受翻修手术。
[J Bone Joint Surg Am. 2020;102-B(10):1368-1374.]
