Department of Orthopaedic Surgery, Nemours Children's Health, Wilmington, DE.
J Pediatr Orthop. 2022 Aug 1;42(7):e736-e741. doi: 10.1097/BPO.0000000000002173. Epub 2022 Jun 1.
Radiographic lucency around a smooth pelvic rod (Galveston/unit rod technique) or sacroiliac/iliac screw following spinal fusion in children with nonambulatory spastic cerebral palsy (CP) has been described as a "windshield wiper" phenomenon. We evaluated demographics, radiographs, and complications in 101 cases from a single center to determine prevalence, risk factors, and complications associated with persistent radiographic lucency from 1 to 5 years following spinal fusion.
Inclusion criteria were diagnosis of nonambulatory spastic quadriplegic CP [Gross Motor Function Classification System (GMFCS) IV-V], under 18 years of age, scoliosis treated by posterior fusion from upper thoracic to sacrum with pelvic fixation (Galveston rod, iliac screw, or sacroiliac screw), adequate radiographs (preoperative, immediate postoperative, first-year, and second-year), and minimum 5-year follow-up. We evaluated demographics, radiographic parameters, comorbidities, scoliosis curve type, type of pelvic screw/rod, use of off-set connector, screw width, associated with posterior column osteotomy and/or additional anterior spinal release concurrent with posterior spine fusion, and infection over the follow-up period. Specific attention was given to the area and shape of the radiographic lucency. The logistic regression analysis was performed for continuous and categorical variables to define risk factors ( P =0.05).
In 101 patients, data were collected at mean intervals of 1-year, 2-year, and >5-year follow-up and were 12.9±1.5, 25.8±2.5, and 81.5±23.0 months, respectively. Prevalence of pelvic rod/screw radiographic lucency was unchanged at 33%, 35%, and 24% at 1-year, 2-year, and >5-year follow-up, respectively, and radiographic parameters did not change ( P >0.05). Furthermore, no risk factors or complications were associated with radiographic lucency around pelvic rods/screws ( P >0.05).
In patients with spastic nonambulatory CP who had scoliosis treated with posterior spinal fusion from upper thorax to pelvis, the prevalence of pelvic rod/screw lucency is high. Persistent lucency >2 mm around pelvic implants is not clinically significant, does not warrant advanced imaging, or indicate a complication if stable over time and wider distally than proximally.
Level III.
在非卧床痉挛性脑瘫（CP）患儿中，后路脊柱融合术后，平滑骨盆杆（Galveston/单位杆技术）或骶髂/髂螺钉周围出现放射状透亮区，被描述为“雨刮器”现象。我们评估了来自单一中心的 101 例患者的人口统计学资料、影像学资料和并发症，以确定脊柱融合后 1-5 年持续放射状透亮的发生率、危险因素和相关并发症。
纳入标准为诊断为非卧床痉挛性四肢瘫 CP[Gross Motor Function Classification System（GMFCS）IV-V]，年龄小于 18 岁，采用后路融合从上胸至骶骨治疗脊柱侧凸，骨盆固定（Galveston 棒、髂螺钉或骶髂螺钉），有足够的影像学资料（术前、术后即刻、术后 1 年和 2 年），随访时间至少 5 年。我们评估了人口统计学资料、影像学参数、合并症、脊柱侧凸曲线类型、骨盆螺钉/棒的类型、使用偏移连接器、螺钉宽度、后路脊柱融合同期后柱截骨术和/或前路脊柱松解术，以及随访期间的感染情况。特别注意放射状透亮区的范围和形状。对连续和分类变量进行逻辑回归分析，以确定危险因素（ P =0.05）。
在 101 例患者中，平均间隔 1 年、2 年和>5 年随访时收集数据，分别为 12.9±1.5、25.8±2.5 和 81.5±23.0 个月。骨盆棒/螺钉放射状透亮的发生率在 1 年、2 年和>5 年随访时分别为 33%、35%和 24%，影像学参数无变化（ P >0.05）。此外，骨盆棒/螺钉周围放射状透亮与任何危险因素或并发症无关（ P >0.05）。
在上胸至骨盆后路脊柱融合术治疗的痉挛性非卧床 CP 患者中，骨盆棒/螺钉透亮的发生率较高。骨盆植入物周围持续>2mm 的透亮区并不具有临床意义，如果在随访期间稳定且远端比近端宽，不需要进行高级影像学检查，也不提示并发症。
III 级。
