动力化-后路腰椎椎间融合术治疗血液透析相关性脊柱关节病：术后2年内影像学结果及再次手术率评估

Dynamization-Posterior Lumbar Interbody Fusion for Hemodialysis-Related Spondyloarthropathy: Evaluation of the Radiographic Outcomes and Reoperation Rate within 2 Years Postoperatively.

作者信息

Yasukawa Taiki, Ohya Junichi, Kawamura Naohiro, Yoshida Yuichi, Onishi Yuki, Kohata Kazuhiro, Kakuta Yohei, Nagatani Satoshi, Kudo Yoshifumi, Shirahata Toshiyuki, Kunogi Junichi

机构信息

Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan.

Department of Orthopedic Surgery, Showa University School of Medicine, Tokyo, Japan.

出版信息

Asian Spine J. 2022 Oct;16(5):684-691. doi: 10.31616/asj.2021.0312. Epub 2022 Mar 10.

DOI:10.31616/asj.2021.0312

PMID:35255544

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9633239/

Abstract

STUDY DESIGN

Clinical case series.

PURPOSE

This study aimed to report dynamization-posterior lumbar interbody fusion (PLIF), our surgical treatment for hemodialysisrelated spondyloarthropathy (HSA), and investigate patients' postoperative course within 2 years.

OVERVIEW OF LITERATURE

HSA often requires lumbar fusion surgery. Conventional PLIF for HSA may cause progressive destructive changes in the vertebral endplate, leading to progressive cage subsidence, pedicle screw loosening, and pseudoarthrosis. A dynamic stabilization system might be effective in patients with a poor bone quality. Thus, we performed "dynamization-PLIF" in hemodialysis patients with destructive vertebral endplate changes.

METHODS

We retrospectively examined patients with HSA who underwent dynamization-PLIF at our hospital between April 2010 and March 2018. The radiographic measurements included lumbar lordosis and local lordosis in the fused segment. The evaluation points were before surgery, immediately after surgery, 1 year after surgery, and 2 years after surgery. The preoperative and postoperative radiographic findings were compared using a paired t-test. A p-value of less than 0.05 was considered significant.

RESULTS

We included 50 patients (28 males, 22 females). Lumbar lordosis and local lordosis were significantly improved through dynamization- PLIF (lumbar lordosis, 28.4°-35.5°; local lordosis, 2.7°-12.8°; p<0.01). The mean local lordosis was maintained throughout the postoperative course at 1- and 2-year follow-up (12.9°-12.8°, p=0.89 and 12.9°-11.8°, p=0.07, respectively). Solid fusion was achieved in 59 (89%) of 66 fused segments. Solid fusion of all fixed segments was achieved in 42 cases (84%). Within 2 years postoperatively, only six cases (12%) were reoperated (two, surgical debridement for surgical site infection; two, reoperation for pedicle screw loosening; one, laminectomy for epidural hematoma; one, additional fusion for adjacent segment disease).

CONCLUSIONS

Dynamization-PLIF showed local lordosis improvement, a high solid fusion rate, and a low reoperation rate within 2 years of follow-up.

摘要

研究设计

临床病例系列。

目的

本研究旨在报告动力化后路腰椎椎间融合术（PLIF），即我们对血液透析相关性脊柱关节病（HSA）的手术治疗方法，并调查患者术后2年内的病程。

文献综述

HSA常需进行腰椎融合手术。传统的用于HSA的PLIF可能会导致椎体终板出现进行性破坏改变，进而导致椎间融合器逐渐下沉、椎弓根螺钉松动和假关节形成。动态稳定系统可能对骨质质量差的患者有效。因此，我们对椎体终板有破坏改变的血液透析患者实施了“动力化-PLIF”手术。

方法

我们回顾性研究了2010年4月至2018年3月在我院接受动力化-PLIF手术的HSA患者。影像学测量包括腰椎前凸和融合节段的局部前凸。评估时间点为术前、术后即刻、术后1年和术后2年。术前和术后的影像学结果采用配对t检验进行比较。p值小于0.05被认为具有统计学意义。

结果

我们纳入了50例患者（男性28例，女性22例）。通过动力化-PLIF，腰椎前凸和局部前凸得到显著改善（腰椎前凸，从28.4°改善至35.5°；局部前凸，从2.7°改善至12.8°；p<0.01）。在术后1年和2年的随访中，平均局部前凸在整个术后病程中得以维持（分别为12.9°至12.8°，p=0.89；12.9°至11.8°，p=0.07）。66个融合节段中有59个（89%）实现了牢固融合。42例（84%）患者的所有固定节段均实现了牢固融合。术后2年内，仅6例（12%）患者接受了再次手术（2例因手术部位感染进行手术清创；2例因椎弓根螺钉松动进行再次手术；1例因硬膜外血肿进行椎板切除术；1例因相邻节段疾病进行额外融合）。