Lee Sang Hyub, Kim Dong-Hwan, Park Jin Hoon, Lee Dong-Geun, Park Choon Keun, Kang Dong Ho
Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Republic of Korea.
Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju-Si, Gyeongsangnam-do, Republic of Korea.
World Neurosurg. 2024 Nov;191:e633-e643. doi: 10.1016/j.wneu.2024.09.014. Epub 2024 Sep 10.
This study aimed to investigate the incidence and risk factors for sacral fractures following lumbosacral fusion.
We conducted a retrospective review of patients who underwent lumbosacral fusion for degenerative spinal stenosis with a minimum follow-up of 2 years. Patients who developed and those who did not develop a sacral fracture were categorized into the "sacral fracture" and "nonfracture" groups. The demographic and radiological data were compared between the 2 groups.
A total of 65 patients were included in this study. Among them, 7 patients were categorized into the sacral fracture and 58 patients into the nonfracture groups, respectively. The incidence of sacral fracture was 10.8%. In the sacral fracture group, age and fusion levels were significantly higher (P<0.05), while bone mineral density (BMD) T-score was significantly lower (P<0.05) than nonfracture group. Pelvic incidence, preoperative pelvic tilt, postoperative sacral slope, and postoperative lumbar lordosis were significantly higher (P<0.05) in the sacral fracture than the nonfracture group. Multivariable logistic regression analysis showed that BMD T-score (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.08-0.79, P = 0.019), postoperative sacral slope (OR 1.14, 95% CI 1.00-1.29, P = 0.047), and changes in L4-S1 lordosis (OR 1.11, 95% CI 1.00-1.23, P = 0.049) were significant factors.
The overall incidence of sacral fracture was 10.8%. In our study, advanced age, low BMD, long fusion levels, and preoperative compensatory pelvic retroversion and excessive correction of it were risk factors for sacral fractures.
本研究旨在调查腰骶部融合术后骶骨骨折的发生率及危险因素。
我们对因退行性腰椎管狭窄症接受腰骶部融合术且随访至少2年的患者进行了回顾性研究。发生骶骨骨折和未发生骶骨骨折的患者分别分为“骶骨骨折”组和“无骨折”组。比较两组的人口统计学和影像学数据。
本研究共纳入65例患者。其中，7例患者被归入骶骨骨折组，58例患者被归入无骨折组，骶骨骨折的发生率为10.8%。骶骨骨折组的年龄和融合节段数显著高于无骨折组（P<0.05），而骨密度（BMD）T值显著低于无骨折组（P<0.05）。骶骨骨折组的骨盆入射角、术前骨盆倾斜度、术后骶骨倾斜度和术后腰椎前凸显著高于无骨折组（P<0.05）。多变量逻辑回归分析显示，BMD T值（比值比[OR]0.25，95%置信区间[CI]0.08 - 0.79，P = 0.019）、术后骶骨倾斜度（OR 1.14，95%CI 1.00 - 1.29，P = 0.047）以及L4 - S1前凸的变化（OR 1.11，95%CI 1.00 - 1.23，P = 0.049）是显著因素。
骶骨骨折的总体发生率为10.8%。在我们的研究中，高龄、低骨密度、长融合节段数以及术前代偿性骨盆后倾及其过度矫正都是骶骨骨折的危险因素。
