Yang Honghao, Li Zhangfu, Hai Yong, Pan Aixing, Guan Li, Liu Yuzeng
Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing, 100020, China.
Eur Spine J. 2023 Oct;32(10):3634-3650. doi: 10.1007/s00586-023-07876-1. Epub 2023 Aug 9.
The incidence of mechanical complications is high in patients undergoing posterior spinal fusion (PSF) for adult spinal deformity (ASD), especially for cases with severe sagittal malalignment or a prior spinal fusion requiring three-column osteotomy (3-CO) or spinopelvic fixation (SPF). The purpose of this systematic review and meta-analysis was to compare the complications, revisions, radiographic spinopelvic parameters, health-related quality of life (HRQoL), and surgical data of PSF using multiple-rod constructs to those of two-rod constructs for the treatment of ASD.
A comprehensive literature search was performed for relevant studies in PubMed, EMBASE, Web of Science, and the Cochrane Library. Complications, revisions, spinopelvic parameters, HRQoL, and surgical date were compared between patients with ASD who underwent PSF using multiple-rod constructs (multi-rod group) and two-rod constructs (two-rod group).
Ten studies, comprising 797 patients with ASD (399 in the multi-rod group and 398 in the two-rod group), were included. All these studies were retrospective cohort studies. There were no significant differences in the surgical, wound-related, and systemic complications between the groups. In the multi-rod group, we noted a significantly lower incidence of rod fracture (RR, 0.43; 95% CI 0.33 to 0.57, P < 0.01), pseudoarthrosis (RR, 0.38; 95% CI 0.28 to 0.53, P < 0.01), and revisions (RR, 0.44; 95% CI 0.33 to 0.58, P < 0.01); a superior restoration of PI-LL (WMD, 3.96; 95% CI 1.03 to 6.88, P < 0.01) and SVA (WMD, 31.53; 95% CI 21.16 to 41.90, P < 0.01); a better improvement of ODI score (WMD, 6.82; 95% CI 2.33 to 11.31, P < 0.01), SRS-22 total score (WMD, 0.44; 95% CI 0.06 to 0.83, P = 0.02), and VAS-BP score (WMD, 1.02; 95% CI 0.31 to 1.73, P < 0.01).
Compared with the two-rod constructs, PSF using multiple-rod constructs was associated with a lower incidence of mechanical complications, a lower revision rate, a superior restoration of sagittal alignment, and a better improvement of HRQoL, without increasing surgical invasiveness. Multiple-rod constructs should be routinely considered to for ASD patients, especially for cases with severe sagittal malalignment or a prior spinal fusion requiring 3-CO or SPF.
在接受后路脊柱融合术（PSF）治疗成人脊柱畸形（ASD）的患者中，机械性并发症的发生率较高，尤其是对于严重矢状面排列不齐或先前已行脊柱融合术且需要三柱截骨术（3-CO）或脊柱骨盆固定术（SPF）的病例。本系统评价和荟萃分析的目的是比较使用多棒结构与双棒结构进行PSF治疗ASD的并发症、翻修情况、影像学脊柱骨盆参数、健康相关生活质量（HRQoL）及手术数据。
在PubMed、EMBASE、科学网和Cochrane图书馆中对相关研究进行全面的文献检索。比较接受使用多棒结构（多棒组）和双棒结构（双棒组）进行PSF的ASD患者之间的并发症、翻修情况、脊柱骨盆参数、HRQoL及手术日期。
纳入了10项研究，共797例ASD患者（多棒组399例，双棒组398例）。所有这些研究均为回顾性队列研究。两组之间在手术、伤口相关及全身并发症方面无显著差异。在多棒组中，我们注意到棒断裂（RR，0.43；95%CI 0.33至0.57，P＜0.01）、假关节形成（RR，0.38；95%CI 0.28至0.53，P＜0.01）及翻修（RR，0.44；95%CI 0.33至0.58，P＜0.01）的发生率显著较低；PI-LL（WMD，3.96；95%CI 1.03至6.88，P＜0.01）和SVA（WMD，31.53；95%CI 21.16至41.90，P＜0.01）的矢状面排列恢复更佳；ODI评分（WMD，6.82；95%CI 2.33至11.31，P＜0.01）、SRS-22总分（WMD，0.44；95%CI 0.06至0.83，P = 0.02）及VAS-BP评分（WMD，1.02；95%CI 0.31至1.73，P＜0.01）改善更好。
与双棒结构相比，使用多棒结构进行PSF与机械性并发症发生率较低、翻修率较低、矢状面排列恢复更佳及HRQoL改善更好相关，且不增加手术侵袭性。对于ASD患者，尤其是对于严重矢状面排列不齐或先前已行脊柱融合术且需要3-CO或SPF的病例，应常规考虑使用多棒结构。
