Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France.
Eur Spine J. 2021 Jul;30(7):1965-1977. doi: 10.1007/s00586-021-06870-9. Epub 2021 May 16.
Four-rod instrumentation and interbody fusion may reduce mechanical complications in degenerative scoliosis surgery compared to 2-rod instrumentation. The purpose was to compare clinical results, sagittal alignment and mechanical complications with both techniques.
Full spine radiographs were analysed in 97 patients instrumented to the pelvis: 58 2-rod constructs (2R) and 39 4-rod constructs (4R). Clinical scores (VAS, ODI, SRS-22, EQ-5D-3L) were assessed preoperatively, at 3 months, 1 year and last follow-up (average 4.2 years). Radiographic measurements were: thoracic kyphosis, lumbar lordosis, spinopelvic parameters, segmental lordosis distribution. The incidence of non-union and PJK were investigated.
All clinical scores improved significantly in both groups between preoperative and last follow-up. In the 2R-group, lumbar lordosis increased to 52.8° postoperatively and decreased to 47.0° at follow-up (p = 0.008). In the 4R-group, lumbar lordosis increased from 46.4 to 52.5° postoperatively and remained at 53.4° at follow-up. There were 8 (13.8%) PJK in the 2R-group versus 6 (15.4%) in the 4R-group, with a mismatch between lumbar apex and theoretic lumbar shape according to pelvic incidence. Non-union requiring revision surgery occurred on average at 26.9 months in 28 patients (48.3%) of the 2R-group. No rod fracture was diagnosed in the 4R-group.
Multi-level interbody fusion combined with 4-rod instrumentation decreased risk for non-union and revision surgery compared to select interbody fusion and 2-rod instrumentation. The role of additional rods on load sharing still needs to be determined when multiple cages are used. Despite revision surgery in the 2R group, final clinical outcomes were similar in both groups.
III.
与 2 棒器械相比，四棒器械和椎间融合可能会降低退行性脊柱侧凸手术的机械并发症。目的是比较两种技术的临床结果、矢状位排列和机械并发症。
对 97 例骨盆内固定的患者进行全脊柱 X 线片分析：58 例 2 棒结构（2R）和 39 例 4 棒结构（4R）。术前、术后 3 个月、1 年和末次随访（平均随访时间 4.2 年）评估临床评分（VAS、ODI、SRS-22、EQ-5D-3L）。影像学测量指标包括：胸椎后凸角、腰椎前凸角、脊柱骨盆参数、节段性腰椎前凸分布。研究非融合和 PJK 的发生率。
两组患者的所有临床评分均在术前和末次随访时显著改善。在 2R 组中，腰椎前凸角术后增加到 52.8°，随访时减少到 47.0°（p=0.008）。在 4R 组中，腰椎前凸角从 46.4 增加到 52.5°，随访时仍保持在 53.4°。2R 组中有 8 例（13.8%）发生 PJK，4R 组中有 6 例（15.4%），与骨盆入射角的理论腰椎形态相比，存在腰椎顶点不匹配。2R 组中有 28 例（48.3%）患者需要翻修手术治疗的非融合，平均发生在术后 26.9 个月。4R 组未发现棒断裂。
与选择性椎间融合和 2 棒器械相比，多节段椎间融合联合 4 棒器械可降低非融合和翻修手术的风险。当使用多个椎间融合器时，附加棒在分担负荷方面的作用仍有待确定。尽管 2R 组进行了翻修手术，但两组的最终临床结果相似。
III。
