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青少年及成人脊柱畸形手术中的个性化棒:叙述性综述

Patient-Specific Rods in Adolescent and Adult Spinal Deformity Surgery: A Narrative Review.

作者信息

Bautista Anson G, Reyes Justin L, Lee Nathan J, Fields Michael W, Sardar Zeeshan M, Lenke Lawrence G, Lombardi Joseph M, Lehman Ronald A

机构信息

Department of Orthopedic Surgery, Eisenhower Army Medical Center, Fort Eisenhower, GA, USA.

Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Och Spine Hospital, New York, NY, USA.

出版信息

Int J Spine Surg. 2024 Aug 30;18(S1):S57-S63. doi: 10.14444/8642.

Abstract

Spinal deformity surgery often requires complex surgical interventions that can have a drastic effect on both patient quality of life and functional capacity. Modern-day corrective solutions for these deformities include spinal osteotomies, pedicle screw instrumentation, and dual/multirod constructs. These solutions are efficacious and are currently considered standard practice for spinal surgeons, but they lack individualization. Patient-specific rods (PSRs) are a novel technology that attempts to offer a personalized approach to spinal deformity correction based on preoperative computerized tomography scans. Moreover, PSRs may offer several advantages to conventional rods, which include achievement of desired rod contour angles according to surgical planning alignment goals, reduced operative time, and reduced blood loss. In adolescent idiopathic scoliosis, those instrumented with PSR have observed coronal Cobb reductions up to 74%. In adult spinal deformity, PSRs have offered superior correction in radiographic parameters such as sagittal vertical axis and pelvic incidence minus lumbar lordosis. However, there still remains a paucity of research in this area, mainly in health care expenditure, cost-effectiveness, and longitudinal clinical outcomes. The purpose of this article is to survey the current body of knowledge of PSR instrumentation in both adolescent and adult spinal deformity populations. The current strength, limitations, and future directions of PSRs are highlighted throughout this article.

摘要

脊柱畸形手术通常需要复杂的手术干预,这可能会对患者的生活质量和功能能力产生巨大影响。针对这些畸形的现代矫正方法包括脊柱截骨术、椎弓根螺钉内固定术以及双棒/多棒结构。这些方法是有效的,目前被脊柱外科医生视为标准术式,但它们缺乏个性化。患者特异性棒(PSR)是一种新技术,试图基于术前计算机断层扫描提供个性化的脊柱畸形矫正方法。此外,PSR可能比传统棒具有多个优势,包括根据手术规划对线目标实现所需的棒轮廓角度、减少手术时间以及减少失血。在青少年特发性脊柱侧凸中,使用PSR进行器械固定的患者观察到冠状面Cobb角减少高达74%。在成人脊柱畸形中,PSR在矢状垂直轴和骨盆入射角减去腰椎前凸等影像学参数方面提供了更好的矫正效果。然而,该领域的研究仍然匮乏,主要集中在医疗保健支出、成本效益和纵向临床结果方面。本文的目的是调查青少年和成人脊柱畸形人群中PSR器械固定的现有知识体系。本文将突出PSR目前的优势、局限性和未来发展方向。

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