Yi Honglei, Chen Hu, Lian Peirong, Ji Xinran, Cunningham Matthew E, Boachie-Adjei Oheneba, Kim Han Jo, Ross Thomas, Nemani Venu M, Xia Hong
People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China.
The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China.
Int Orthop. 2024 Jan;48(1):193-200. doi: 10.1007/s00264-023-05951-2. Epub 2023 Aug 24.
This study aims to investigate the fusion rate and complications associated with trans-sacral interbody fusion (TSIF) in long fusions to the sacrum for adult spinal deformity (ASD) over a two year follow-up period. Potential predictor variables associated with pseudarthrosis were also examined.
A retrospective clinical review was conducted on a consecutive series of ASD patients who underwent long fusions to the sacrum, with TSIF performed as a same-day or staged procedure. Patient demographics, bone mineral density, operative details, perioperative and late complications, and fusion rates were reviewed. Univariate analysis was used to identify the risk factors associated with pseudarthrosis.
The study included 43 patients with an average age of 55.3 ± 8.9 years. The perioperative complication rate was 28%, with 12% of the complications directly related to TSIF. The late complication rate was 33%, with 16% related to TSIF. The most common complications were pseudarthrosis (14%) and postoperative ileus (7%). The overall radiographic fusion rate at two years was 86%. Univariate analysis revealed that revision surgery was significantly associated with pseudarthrosis (p = 0.027). Over the follow-up period, patients who underwent TSIF during long posterior fusions to the sacrum showed improvement in overall SRS scores, ODI scores, and SF-36 physical health and mental health (p < 0.05).
TSIF is a relatively safe and minimally invasive method for achieving interbody fusion at the lumbosacral junction in the treatment of ASD, with acceptable fusion rates and a low complication rate. However, TSIF is not recommended for revision reconstruction in ASD.
本研究旨在调查成人脊柱畸形（ASD）行长节段骶骨融合术时经骶骨椎间融合术（TSIF）在两年随访期内的融合率及相关并发症。还对与假关节形成相关的潜在预测变量进行了研究。
对一系列连续的行长节段骶骨融合术的ASD患者进行回顾性临床分析，TSIF作为同日或分期手术进行。回顾了患者的人口统计学资料、骨密度、手术细节、围手术期和晚期并发症以及融合率。采用单因素分析确定与假关节形成相关的危险因素。
该研究纳入43例患者，平均年龄55.3±8.9岁。围手术期并发症发生率为28%，其中12%的并发症与TSIF直接相关。晚期并发症发生率为33%，其中16%与TSIF相关。最常见的并发症是假关节形成（14%）和术后肠梗阻（7%）。两年时的总体影像学融合率为86%。单因素分析显示翻修手术与假关节形成显著相关（p = 0.027）。在随访期间，在长节段后路骶骨融合术中接受TSIF的患者在总体SRS评分、ODI评分以及SF-36身体健康和心理健康方面均有改善（p < 0.05）。
TSIF是治疗ASD时在腰骶部实现椎间融合的一种相对安全且微创的方法，融合率可接受且并发症发生率低。然而，不建议在ASD中使用TSIF进行翻修重建。
