Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University.
Department of Orthopaedic Surgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University.
World Neurosurg. 2021 May;149:e563-e569. doi: 10.1016/j.wneu.2021.01.134. Epub 2021 Feb 5.
We investigated the characteristics and revision rate of junctional failure after surgical correction for thoracolumbar kyphosis in patients with ankylosing spondylitis.
A total of 230 patients had undergone surgical correction for thoracolumbar kyphosis from 2010 to 2019. The state of ankylosis between the uppermost instrumented vertebra (UIV) and UIV+1 and between the lowermost instrumented vertebra (LIV) and LIV-1 was analyzed using a modified Stoke ankylosing spondylitis spine score. Proximal junctional failure (PJF) and distal junctional failure (DJF) were defined as any type of symptomatic junctional failure.
Of the 230 patients, 23 (10.0%) had developed junctional failure. Of these 23 patients, 16 had had partial ankylosis and 7 had had complete ankylosis. PJF had developed in 10 patients and DJF in 13. The most common type of junctional failure was a junctional fracture, which developed in 12 patients. PJF had developed by UIV fracture in 4 patients, UIV+1 fracture in 1 patient, and UIV+2 in 1 patient. DJF had developed by LIV fracture in 6 patients, metallic failure in 5, and progression of DJF in 2 patients. The average time to the development of PJF and DJF was 13 months and 12.4 months, respectively. All 10 patients with PJF and 7 of 13 patients with DJF (53.8%) had required reoperation. Of the 12 patients with junctional fracture, 11 (91.7%) had undergone reoperation.
Of the 23 patients with junctional failure, 16 had had immature ossification of the anterior longitudinal ligament. Therefore, to prevent junctional failure, the state of ankylosis seems to be important for selecting the fusion level after osteotomy. Once junctional failure has developed, however, reoperation should be considered owing to the stress concentration at the UIV or LIV.
研究强直性脊柱炎胸腰椎后凸畸形患者后路矫形术后交界区失败的特点和返修率。
2010 年至 2019 年，共 230 例患者接受了胸腰椎后凸畸形后路矫形术。采用改良 Stoke 强直性脊柱炎脊柱评分分析最上固定椎（UIV）与 UIV+1 之间以及最下固定椎（LIV）与 LIV-1 之间的融合状态。近端交界区失败（PJF）和远端交界区失败（DJF）定义为任何类型的有症状交界区失败。
230 例患者中，23 例（10.0%）发生交界区失败。这 23 例患者中，16 例为部分性融合，7 例为完全性融合。10 例发生 PJF，13 例发生 DJF。最常见的交界区失败类型为交界区骨折，共 12 例。4 例发生 UIV 骨折，1 例发生 UIV+1 骨折，1 例发生 UIV+2 骨折，导致 PJF。6 例发生 LIV 骨折，5 例发生金属疲劳，2 例发生 DJF 进展，导致 DJF。PJF 和 DJF 的平均发病时间分别为 13 个月和 12.4 个月。10 例 PJF 患者和 13 例 DJF 患者中的 7 例（53.8%）均需再次手术。12 例交界区骨折患者中，11 例（91.7%）接受了再次手术。
23 例交界区失败患者中，16 例存在不成熟的前纵韧带骨化。因此，为了预防交界区失败，术后融合节段的选择似乎与融合状态有关。然而，一旦发生交界区失败，由于 UIV 或 LIV 处的应力集中，应考虑再次手术。
