Chanbour Hani, Hassan Fthimnir M, Zuckerman Scott L, Park Paul J, Morrissette Cole, Cerpa Meghan, Lee Nathan J, Ha Alex S, Lehman Ronald A, Lenke Lawrence G
Department of Neurological Surgery, Vanderbilt University Medical Center, Medical Center North T-4224, Nashville, TN, 37212, USA.
The Spine Hospital, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA.
Spine Deform. 2023 Mar;11(2):471-479. doi: 10.1007/s43390-022-00611-8. Epub 2022 Nov 18.
(1) To describe the use of multi-rod constructs (MRCs) in adult spinal deformity (ASD) surgery, (2) to report rod fractures occurring at MRC sites, and (3) to evaluate risk factors for rod fractures.
A single-center, retrospective cohort study was conducted of patients undergoing ASD surgery with these inclusion criteria: minimum 2-year follow-up, MRCs used, ≥ 10-level fusion, and fused to sacrum/pelvis. The primary outcome was rod fracture. Univariate/multivariate logistic regression was performed controlling for age, kickstand rod usage, number of rods across the lumbosacral junction (LSJ), and the amount of coronal/sagittal Cobb correction.
Among 57 patients undergoing ASD surgery with MRCs, mean age was 60 ± 11 years. With respect to MRCs, 32 (56%) patients had 3 rods, 18 (32%) had 4, and 7 (12%) had 5. Rods crossing the LSJ were most often three (63%), followed by four (25%) and five (5%) rods. Nine (16%) patients experienced rod fractures with eight (89%) patients having no more than three rods crossing the LSJ. A coronal correction > 30 mm was more often seen in patients with rod fracture (p = 0.030), while an SVA correction > 50 mm was not significantly different (p = 0.608). Multivariate logistic regression revealed that the amount of coronal correction was significantly associated with rod fracture (OR 1.03, 95% CI 1.01-1.07, p = 0.044), as was achieving a coronal correction > 30 mm (OR 7.72, 95% CI 1.17-51.10, p = 0.034), with no association between the amount of sagittal correction obtained and rod fracture.
This study found that greater coronal correction was associated with an increased odds of rod fracture. We suggest adding at least four rods across the LSJ cephalad to the interbody fusions to avoid rod fractures in these high demand areas.
III.
（1）描述多棒结构（MRC）在成人脊柱畸形（ASD）手术中的应用，（2）报告MRC部位发生的棒材骨折，（3）评估棒材骨折的危险因素。
对符合以下纳入标准的接受ASD手术的患者进行单中心回顾性队列研究：至少2年随访、使用MRC、≥10节段融合且融合至骶骨/骨盆。主要结局为棒材骨折。进行单因素/多因素逻辑回归分析，控制年龄、使用支撑棒、腰骶关节（LSJ）处棒材数量以及冠状面/矢状面Cobb角矫正量。
在57例接受MRC ASD手术的患者中，平均年龄为60±11岁。关于MRC，32例（56%）患者有3根棒材，18例（32%）有4根，7例（12%）有5根。穿过LSJ的棒材最常见为3根（63%），其次是4根（25%）和5根（5%）。9例（16%）患者发生棒材骨折，其中8例（89%）穿过LSJ的棒材不超过3根。棒材骨折患者中冠状面矫正>30mm更为常见（p = 0.030），而矢状面垂直轴（SVA）矫正>50mm无显著差异（p = 0.608）。多因素逻辑回归显示，冠状面矫正量与棒材骨折显著相关（比值比[OR]1.03，95%置信区间[CI]1.01 - 1.07，p = 0.044），冠状面矫正>30mm也与棒材骨折显著相关（OR 7.72，95%CI 1.17 - 51.10，p = 0.034），而矢状面矫正量与棒材骨折无关联。
本研究发现更大的冠状面矫正与棒材骨折几率增加相关。我们建议在椎间融合上方的LSJ处至少增加4根棒材，以避免这些高需求区域的棒材骨折。
III级。
