成人脊柱畸形行腰骶部固定后骨盆入射角会发生改变吗？这种改变会受到骨盆固定类型的影响吗？
Can Pelvic Incidence Change After Lumbo-Pelvic Fixation for Adult Spine Deformity, and Would the Change be Affected by the Type of Pelvic Fixation?
作者信息
Rizkallah Maroun, Shen Jesse, Phan Philippe, Al-Shakfa Fidaa, Kamel Yousef, Liu Jia, Shedid Daniel, Yuh Sung Joo, Boubez Ghassan, Wang Zhi
机构信息
Department of Orthopedic Surgery, University of Montreal Health Center, Montreal, Quebec, Canada.
Division of Orthopaedic Surgery, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada.
出版信息
Spine (Phila Pa 1976). 2024 Jan 1;49(1):E1-E7. doi: 10.1097/BRS.0000000000004651. Epub 2023 Mar 27.
STUDY DESIGN
Retrospective review.
OBJECTIVE
To assess the change in pelvic incidence (PI) after lumbo-pelvic fixation and the differential impact of the type of pelvic fixation: S2-alar-iliac screws (S2AI) versus Iliac screws (IS) on postoperative PI.
SUMMARY OF BACKGROUND DATA
Recent studies suggest that changes occur to the previously assumed fixed PI after spino-pelvic fixation.
METHODS
Adult spine deformity (ASD) patients who underwent spino-pelvic fixation with≥4 levels of fusion were included. Preoperative and postoperative PI, lumbar lordosis (LL), thoracic kyphosis, pelvic tilt, sacral slope, PI-LL mismatch, and the Sagittal Vertical Axis (SVA) were analyzed on EOS imaging. A significant PI change was established at≥6°. Patients were categorized based on the type of pelvic fixation (S2AI vs. IS).
RESULTS
One-hundred-forty-nine patients were included. Of these, 77(52%) had a>6° change in their PI postoperatively. In patients with high preoperative PI (>60°), 62% had a significant PI change compared with 33% of patients with normal PI (40°-60°) and 53% in patients with low PI (<40°; P =0.01). PI was likely to decrease in patients with high baseline PI (>60°) and to increase in patients with low baseline PI (<40°). Patients with a significant PI change had a higher PI-LL. Patients in the S2AI group (n=99) and those in the IS group (n=50) were comparable at baseline. In the S2AI group, 50 (51%) patients had>6° change in their PI compared with 27(54%) patients in the IS group( P =0.65). In both groups, patients with high preoperative PI were more prone to significant postoperative changes ( P =0.02 in IS, P =0.01 in S2AI).
CONCLUSION
PI changed significantly in 50% of patients postoperatively, especially in those with high/low preoperative PI and those with severe baseline sagittal imbalance. This occurs similarly in patients with S2AI and those with IS screws. Surgeons should keep in mind these anticipated changes while planning ideal LL, as this impacts postoperative PI-LL mismatch.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
评估腰骶部固定术后骨盆入射角（PI）的变化，以及骨盆固定类型（S2 翼状髂骨螺钉[S2AI]与髂骨螺钉[IS]）对术后 PI 的不同影响。
背景数据总结
近期研究表明，脊柱骨盆固定后，先前认为固定不变的 PI 会发生变化。
方法
纳入接受≥4 节段融合的脊柱骨盆固定的成人脊柱畸形（ASD）患者。在 EOS 成像上分析术前和术后的 PI、腰椎前凸（LL）、胸椎后凸、骨盆倾斜、骶骨坡度、PI-LL 不匹配以及矢状垂直轴（SVA）。PI 变化≥6°被判定为有显著变化。根据骨盆固定类型（S2AI 与 IS）对患者进行分类。
结果
共纳入 149 例患者。其中，77 例（52%）术后 PI 变化>6°。术前 PI 高（>60°）的患者中，62%有显著的 PI 变化，而术前 PI 正常（40°-60°）的患者为 33%，术前 PI 低（<40°）的患者为 53%（P =0.01）。基线 PI 高（>60°）的患者 PI 可能降低，而基线 PI 低（<40°）的患者 PI 可能升高。有显著 PI 变化的患者 PI-LL 更高。S2AI 组（n =99）和 IS 组（n =50）患者在基线时具有可比性。S2AI 组中，50 例（51%）患者 PI 变化>6°，而 IS 组为 27 例（54%）患者（P =0.65）。两组中，术前 PI 高的患者术后更易发生显著变化（IS 组 P =0.02，S2AI 组 P =0.01）。
结论
50%的患者术后 PI 发生显著变化，尤其是术前 PI 高/低以及基线矢状面严重失衡的患者。S2AI 螺钉固定患者和 IS 螺钉固定患者情况相似。外科医生在规划理想的 LL 时应牢记这些预期变化，因为这会影响术后 PI-LL 不匹配。
证据等级
4 级。
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