Gertzbein S D, Hollopeter M R, Hall S
Department of Orthopedics, Baylor College of Medicine, Houston, Texas.
Spine (Phila Pa 1976). 1998 Nov 1;23(21):2352-6; discussion 2356-7. doi: 10.1097/00007632-199811010-00021.
Twenty-five patients with a pseudarthrosis after previous spinal fusion surgery were reviewed after a circumferential fusion was performed.
To determine the fusion rate and its relation to outcome, i.e., pain reduction and return to work, and associated complications.
Circumferential fusion has become a common procedure with more patients undergoing multiple operations. This operation is thought to improve the fusion rate with a low complication rate. However, the procedure has not been evaluated specifically for the management of pseudarthrosis.
Twenty-five patients were reviewed regarding age, gender, smoking status, previous back surgeries, extent of leg and back pain, occupation, levels of surgery, type of instrumentation, blood loss, and complications. A minimum follow-up period of 2 years included evaluation of radiographs, pain levels, medication, and return to work.
Twenty percent of patients were heavy smokers. An average of 2.2 previous procedures had been performed, and the average follow-up period was 2.7 years. Eighty percent of patients underwent multiple-level fusions. A solid fusion was achieved in 100%. Complications included two painful instrumentation devices requiring removal, one retroperitoneal hematoma, one anterior abdominal wall dehiscence, and one case of pneumonia. Pain scores improved from 7.4 to 4.7 for back pain, and 5.4 to 2.8 for leg pain, respectively. Both improvements were statistically significant (P < 0.01 and 0.003, respectively). However, only 52% of patients reduced their pain by a full category. Forty-one percent were still taking narcotics intermittently or consistently, and 53% returned to work or were actively seeking employment.
A fusion rate of 100% was noted in the face of factors often placing patients at high risk for developing a pseudarthrosis, namely multiple levels of previous spinal surgery, including previous pseudarthrosis, and a habit of heavy smoking. Complications were few. However, the satisfactory outcome rate was only somewhat better than 50%, based on a lack of substantial pain improvement and return to work.
对25例既往脊柱融合手术后出现假关节的患者进行了环形融合术后评估。
确定融合率及其与结果的关系，即疼痛减轻和恢复工作情况，以及相关并发症。
环形融合术已成为一种常见手术，越来越多的患者接受多次手术。该手术被认为可提高融合率且并发症发生率低。然而，该手术尚未针对假关节的治疗进行专门评估。
对25例患者的年龄、性别、吸烟状况、既往背部手术史、腿部和背部疼痛程度、职业、手术节段、内固定类型、失血量和并发症进行了评估。至少2年的随访期包括对X光片、疼痛程度、用药情况和恢复工作情况的评估。
20%的患者为重度吸烟者。平均之前进行过2.2次手术，平均随访期为2.7年。80%的患者接受了多节段融合术。100%实现了坚固融合。并发症包括2例需要取出的疼痛性内固定装置、1例腹膜后血肿、1例前腹壁裂开和1例肺炎。背痛评分从7.4改善至4.7，腿痛评分从5.4改善至2.8。两者改善均具有统计学意义（分别为P < 0.01和0.003）。然而，只有52%的患者疼痛完全减轻一个等级。41%的患者仍在间歇或持续服用麻醉药品，53%的患者恢复工作或正在积极寻找工作。
尽管存在一些常使患者发生假关节风险较高的因素，如既往多节段脊柱手术，包括既往假关节，以及重度吸烟习惯，但仍实现了100%的融合率。并发症较少。然而，基于疼痛改善不显著和恢复工作情况，满意的结果率仅略高于50%。
