Thompson Jeremy C, Marigi Erick, Cross William W
Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA
Department of Orthopedic Surgery, Mayo Clinic, Rochester, USA.
Int J Spine Surg. 2023 Apr;17(2):250-257. doi: 10.14444/8421. Epub 2023 Feb 8.
Sacroiliac joint fusion (SIJF) has been established as an effective treatment for sacroiliac joint dysfunction. However, failure necessitating revision has been reported in up to 30% of cases. Little is known regarding outcomes of revision SIJF.
We retrospectively reviewed all revision SIJF at a single academic center between 2017 and 2020. Revision surgery was performed using the principles of joint decortication, bone grafting, compression, and rigid internal fixation. Outcomes were assessed at 6 months and 1 year after surgery using the Oswestry Disability Index (ODI), Numeric Pain Rating Scale (NPRS), and Single Assessment Numeric Evaluation (SANE) scale. Fusion was assessed using computed tomography at 12 months postoperatively.
Eighteen revision SIJFs in 13 patients were included. The mean age was 55.8 years (range 35-75). Mean body mass index was 27.9 (range 21.7-36.7). Sixty-two percent of the patients were women. The indications for revision were pseudarthrosis without fixation failure in 14 cases (77.8%), hardware failure (loosening) in 3 cases (16.7%), and continued pain after partial fusion in 1 case (5.6%). ODI and NPRS scores demonstrated significant statistical and clinical improvements at all timepoints. Mean (SD) ODI scores improved from 53.8 (19.9) preoperative to 37.5 (19.8) at 6 months and 32.9 (21.7) at 12 months. Improvement in ODI was found in 15 joints (83.3%), and the minimal clinically important difference (MCID) was achieved in 12 joints (66.7%). Mean (SD) NPRS scores improved from 6.5 (1.4) preoperative to 3.2 (2.8) at 6 months and 3.4 (2.6) at 12 months. Improvement in NPRS was also identified in 17 joints (94.4%), and 10 joints (55.6%) achieved MCID for NPRS. Mean (SD) SANE score was 72.0% (30.8) at 6 months and 70.0% (33.8) at 12 months. There were no radiographic lucencies, implant subsidence, or implant fractures at final follow-up. We identified an 88.9% fusion rate with definitive bridging bone across the sacroiliac joint.
Utilizing a principles-based technique of joint decortication, compression, and rigid internal fixation, revision SIJF showed an improvement in patient-reported outcomes as well as high rate of fusion at 12 months. The most common indications for revision SIJF are symptomatic pseudarthrosis and implant loosening. This is the largest series of revision SIJF to date.
骶髂关节融合术（SIJF）已被确立为治疗骶髂关节功能障碍的有效方法。然而，据报道，高达30%的病例需要进行翻修手术。关于翻修骶髂关节融合术的结果知之甚少。
我们回顾性分析了2017年至2020年在单一学术中心进行的所有翻修骶髂关节融合术。翻修手术采用关节去皮质、植骨、加压和坚强内固定的原则进行。在术后6个月和1年使用Oswestry功能障碍指数（ODI）、数字疼痛评分量表（NPRS）和单项评估数字评价（SANE）量表评估结果。术后12个月使用计算机断层扫描评估融合情况。
纳入13例患者的18例翻修骶髂关节融合术。平均年龄为55.8岁（范围35 - 75岁）。平均体重指数为27.9（范围21.7 - 36.7）。62%的患者为女性。翻修的指征为14例（77.8%）无固定失败的假关节形成、3例（16.7%）内固定失败（松动）和1例（5.6%）部分融合后持续疼痛。ODI和NPRS评分在所有时间点均显示出显著的统计学和临床改善。平均（标准差）ODI评分从术前的53.8（19.9）改善到6个月时的37.5（19.8）和12个月时的32.9（21.7）。15个关节（83.3%）的ODI有所改善，12个关节（66.7%）达到最小临床重要差异（MCID）。平均（标准差）NPRS评分从术前的6.5（1.4）改善到6个月时的3.2（2.8）和12个月时的3.4（2.6）。17个关节（94.4%）的NPRS也有所改善，10个关节（55.6%）达到NPRS的MCID。平均（标准差）SANE评分在6个月时为72.0%（30.8），在12个月时为70.0%（33.8）。末次随访时无影像学透亮区、植入物下沉或植入物骨折。我们发现骶髂关节有明确桥接骨的融合率为88.9%。
采用基于原则的关节去皮质、加压和坚强内固定技术，翻修骶髂关节融合术在患者报告的结果方面有所改善，且12个月时融合率高。翻修骶髂关节融合术最常见的指征是有症状的假关节形成和植入物松动。这是迄今为止最大的一组翻修骶髂关节融合术病例系列。
