Lagrone M O, Bradford D S, Moe J H, Lonstein J E, Winter R B, Ogilvie J W
Orthopaedic Service, Letterman Army Medical Center, Presidio San Francisco, California 94129.
J Bone Joint Surg Am. 1988 Apr;70(4):569-80.
Fifty-five patients who had loss of lumbar lordosis after spinal fusion and subsequently had corrective osteotomies were studied. When they were first seen, fifty-two patients (95 per cent) were unable to stand erect and forty-nine (89 per cent) had back pain. The previous use of distraction instrumentation with a hook placed at the level of the lower lumbar spine or the sacrum was the factor that was most frequently identified as leading to the development of the flatback syndrome. Sixty-six extension osteotomies were performed in these fifty-five patients. Nineteen patients (35 per cent) had an associated anterior spinal fusion. Thirty-three patients (60 per cent) had one or more complications, including pseudarthrosis, a dural tear, failure of hardware, neurapraxia, and urinary tract infection. The results of the operation were evaluated at follow-up by review of clinical records, radiographs, and questionnaires. At an average follow-up of six years (range, two to fourteen years), most patients felt that they had benefited from the corrective osteotomies. However, twenty-six patients (47 per cent) continued to lean forward and twenty patients (36 per cent) continued to have moderate or severe back pain. The failure to restore sagittal plane balance led to a higher rate of pseudarthrosis, which was associated with recurrent deformity. Anterior spinal fusion combined with posterior osteotomy resulted in greater maintenance of correction. The prevention of flatback syndrome is important, since its treatment is difficult. When a spinal fusion must be extended to the level of the lower lumbar spine or the sacrum, the use of distraction instrumentation should be avoided in order to prevent this deformity.
对55例脊柱融合术后出现腰椎前凸消失并随后接受矫正截骨术的患者进行了研究。初次就诊时，52例患者（95%）无法直立，49例患者（89%）有背痛。先前在下腰椎或骶骨水平使用带钩的撑开器械是最常被认为导致平背综合征发生的因素。在这55例患者中进行了66次伸展截骨术。19例患者（35%）同时进行了前路脊柱融合术。33例患者（60%）出现了一种或多种并发症，包括假关节形成、硬脊膜撕裂、内固定失败、神经失用症和尿路感染。通过回顾临床记录、X线片和问卷调查对随访时的手术结果进行评估。平均随访6年（范围为2至14年），大多数患者认为他们从矫正截骨术中获益。然而，26例患者（47%）继续向前倾，20例患者（36%）继续有中度或重度背痛。矢状面平衡未能恢复导致假关节形成率更高，这与畸形复发有关。前路脊柱融合术联合后路截骨术能更好地维持矫正效果。预防平背综合征很重要，因为其治疗困难。当脊柱融合术必须延伸至下腰椎或骶骨水平时，应避免使用撑开器械以防止这种畸形。
