Bao H D, Zhang T Y, Shu S B, Liu Z, Sun X, Wang B, Qian B P, Yu Y, Qiu Y, Zhu Z Z
Department of Spine Surgery, the Affiliated Nanjing Drum Tower Hospital of Nanjing University, Nanjing 210008, China.
Zhonghua Yi Xue Za Zhi. 2021 Jun 8;101(21):1560-1565. doi: 10.3760/cma.j.cn112137-20201019-02868.
To analyze the occurrence of rod fracture after surgery for lumbosacral deformity associated sacral agenesis and discuss the relevant salvage methods. The clinical records of 19 patients who underwent surgical treatment for lumbosacral deformity associated sacral agenesis from January 2001 to January 2018 were retrospectively reviewed, including 11 boys and 8 girls. The average age was (9.6±5.2) years. The outcomes of surgical correction and internal fixation were evaluated by postoperative regular follow-up. We also recorded the time and position of rod fracture occurrence. The Cobb angle, coronal balance and sagittal balance were measured and compared to analyze the corresponding salvage methods and revision outcomes. Three patients encountered rod fracture during follow-up, so the incidence of rod fracture after surgery for lumbosacral deformity associated sacral agenesis was 15.8%(3/19). Based on their own conditions, we formulated the individualized strategy and performed the revision surgery through the posterior-only approach. The most critical step was abundant bone-grafting and fusion in the defected sacroiliac joint. After revision, the scoliotic Cobb angle improved in two patients (91.5° vs 47.5°, 49.0° vs 28.0°) and coronal balance improved in one patient (40.3 mm vs 24.3 mm). No complication reoccurred during follow-up. The rod fracture after surgery for lumbosacral deformity associated sacral agenesis is quite common, which is probably correlated with its unique deformed structure and biomechanical characteristics. The individualized salvage methods and adequate bone-grafting and fusion for the defected sacroiliac joint will guarantee the reconstruction and maintenance of spine balance after revision.
分析腰骶部畸形合并骶骨发育不全手术后棒材断裂的发生情况，并探讨相关的挽救方法。回顾性分析2001年1月至2018年1月期间接受腰骶部畸形合并骶骨发育不全手术治疗的19例患者的临床记录，其中男11例，女8例。平均年龄为（9.6±5.2）岁。通过术后定期随访评估手术矫正和内固定的效果。我们还记录了棒材断裂发生的时间和位置。测量并比较Cobb角、冠状面平衡和矢状面平衡，以分析相应的挽救方法和翻修效果。3例患者在随访期间发生棒材断裂，因此腰骶部畸形合并骶骨发育不全手术后棒材断裂的发生率为15.8%（3/19）。根据患者自身情况，我们制定了个体化策略，并通过单纯后路进行翻修手术。最关键的步骤是在缺损的骶髂关节处进行充分的植骨和融合。翻修后，2例患者的脊柱侧弯Cobb角得到改善（91.5°对47.5°，49.0°对28.0°），1例患者的冠状面平衡得到改善（40.3 mm对24.3 mm）。随访期间无并发症复发。腰骶部畸形合并骶骨发育不全手术后的棒材断裂相当常见，这可能与其独特的畸形结构和生物力学特征有关。个体化的挽救方法以及对缺损骶髂关节进行充分的植骨和融合将确保翻修后脊柱平衡的重建和维持。
