Kimura Atsushi, Shiraishi Yasuyuki, Sawamura Hideaki, Inoue Hirokazu, Takeshita Katsushi
Department of Orthopaedic Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
J Orthop Surg Res. 2024 Jan 27;19(1):91. doi: 10.1186/s13018-024-04572-8.
To achieve optimal correction of rigid kyphoscoliosis, we developed a novel two-stage posterior-anterior-posterior (PAP) surgery using subcutaneously preserved autologous bone grafts. This study aimed to investigate the effectiveness of two-stage PAP surgery versus single-stage anterior-posterior (AP) surgery.
This was a retrospective analysis of patients undergoing combined anterior-posterior long-level fusion for adult spinal deformity (ASD) with a minimum 2-year follow-up. The indications for two-stage PAP surgery were rigid thoracolumbar deformity associated with hypertrophic facet arthritis and/or a large pelvic incidence-lumbar lordosis mismatch of > 25°. In the first stage of PAP surgery, pedicle screw insertion and multilevel Ponte osteotomies were performed. The resected local bone was embedded under sutured fascia. One week later, the embedded bone was retrieved in the right lateral position and used as an autograft for lateral lumbar interbody fusion. Final deformity correction was performed in the prone position.
From January 2018 to April 2021, 12 and 16 patients with ASD underwent two-stage PAP surgery (PAP group) and single-stage AP surgery (AP group), respectively. Although PAP surgery was associated with a significantly longer operation time, the total blood loss volume was significantly less in the PAP group than the AP group. Compared with the AP group, the PAP group showed significantly larger postoperative changes in radiological parameters in the sagittal and coronal planes. The overall complication rate did not differ significantly between the two groups.
Two-stage PAP surgery provided effective correction of rigid kyphoscoliosis without increasing blood loss and postoperative complication rates.
为实现对僵硬性脊柱侧凸的最佳矫正，我们开发了一种新型的两阶段前后后（PAP）手术，使用皮下保存的自体骨移植。本研究旨在探讨两阶段PAP手术与单阶段前后（AP）手术的有效性。
这是一项对接受成人脊柱畸形（ASD）前后联合长节段融合且至少随访2年的患者的回顾性分析。两阶段PAP手术的适应证为与肥厚性小关节关节炎相关的僵硬性胸腰段畸形和/或骨盆入射角与腰椎前凸失配大于25°。在PAP手术的第一阶段，进行椎弓根螺钉置入和多节段庞特截骨术。切除的局部骨埋置于缝合的筋膜下。一周后，在右侧卧位取出埋置的骨并用作腰椎椎间融合的自体移植物。最终的畸形矫正在俯卧位进行。
2018年1月至2021年4月，分别有12例和16例ASD患者接受了两阶段PAP手术（PAP组）和单阶段AP手术（AP组）。尽管PAP手术的手术时间明显更长，但PAP组的总失血量明显少于AP组。与AP组相比，PAP组在矢状面和冠状面的放射学参数术后变化明显更大。两组的总体并发症发生率无显著差异。
两阶段PAP手术可有效矫正僵硬性脊柱侧凸，且不增加失血量和术后并发症发生率。
