摘要
目的探讨应用卫星棒技术行脊柱矫形术治疗严重脊柱侧后凸畸形术后断棒的发生率及其原因。方法2012年7月至2017年6月应用卫星棒技术行脊柱矫形术治疗严重脊柱侧后凸畸形共234例,回顾性分析术后发生断棒的6例患者病历资料,分别测量术前、术后、断棒时、翻修后及末次随访时的侧凸Cobb角、最大后凸Cobb角(global kyphosis, GK)、冠状面平衡(distance between C7 plumb line and center sacral vertical line, C7PL-CSVL)和矢状面平衡(sagittal vertical axis, SVA)等参数,并且记录发生断棒的时间及部位,分析断棒的原因。结果卫星棒技术矫形手术后断棒发生率为2.6%(6/234)。6例患者中男3例、女3例,平均初次手术年龄为(34.5±15.4)岁。断棒发生的平均时间为术后(24.0±17.7)个月,其中3例(50%)发生在术后1年之内。共发生7根内固定棒断裂,4根(57%)棒断裂部位为应力集中区且均位于单棒固定侧、3根(43%)棒断裂部位位于卫星棒固定的邻近节段。断棒后侧凸Cobb角平均矫正丢失20.8°±29.4°、GK平均矫正丢失34.0°±21.4°。内固定棒断裂的原因为残留后凸3例、假关节形成2例、长节段固定3例、外伤1例。6例断棒患者中3例(50%)患者于发现断棒后即刻进行翻修手术,翻修手术方案均为取出断棒更换为新棒,于卫星棒未固定侧增加卫星棒固定,并于围断棒区重新植骨融合,翻修后随访期间均无内固定松动、断裂等;另3例于断棒后行保守治疗,随访期间无异常不适,继续观察中。结论应用卫星棒技术行脊柱矫形术后内固定棒断裂的发生率为2.6%,断棒位置多为应力集中的单棒固定侧或卫星棒邻近节段。残留后凸、假关节形成、长节段固定至骨盆、外伤是严重脊柱畸形患者应用卫星棒技术行脊柱矫形术后发生断棒的原因。
Objective To investigate the incidence and risk factors for rod fracture after correction surgery with satellite rod in severe spinal deformity.Methods A retrospective analysis was made including 234 cases who underwent correction surgery using satellite rod technique for severe spinal deformity in our hospital from July 2012 to June 2017. At the last follow-up, a total of 6 patients were found to have rod fracture. All the patients had complete clinical and imaging data at the time of preoperation, postoperation, rod fracture occurring, post-revision and the last follow-up. The Cobb angle, the Global kyphosis (GK), the coronal balance (distance between C7 plumb line and center sacral vertical line, C7PL-CSVL) and the sagittal vertical axis (SVA) were measured respectively in the 6 patients with rod fracture during the follow-up process. The time, incidence and position of the broken rod were recorded, and the reasons of rod fracture were analyzed for each patient.Results The incidence of rod fracture was 2.6% (6/234) in the current study. The 6 patients included 3 males and 3 females with an average age of 34.5±15.4 years at initial surgery. The mean time of rod fracture was 24.0±17.7 months, of which 3 cases (50%) occurred within 1 years after operation. A total of 7 rods were broken, including 4 (57%) rods located at the single-rod-fixed side with stress concentration and 3 (50%) rods at the adjacent segment of the satellite rod. The average loss of correction was 20.8°±29.4° for Cobb angle and 34.0°±21.4° for GK. The potential reasons for rod fracture were listed as follows: 3 cases for residual kyphosis;2 cases for pseudarthrosis;3 cases for long fusion construct crossing lumbosacral junction;1 case for trauma. Of the 6 patients with rod fracture, 3 (43%) patients underwent revision surgery by replacing the broken rods, adding satellite rod at the opposite side of pre-existing satellite rod and bone graft at the rod-breakage area. The other 3 patients underwent observation and no deterioration was fo
作者
史本龙
夏三强
李洋
石博
刘盾
刘臻
朱泽章
邱勇
Shi Benlong;Xia Sanqiang;Li Yang;Shi Bo;Liu Dun;Liu Zhen;Zhu Zezhang;Qiu Yong(Department of Spine Surgery,Drum Town Hospital,Medical School of Nanjing University,Nanjing 210008,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2019年第4期209-215,共7页
Chinese Journal of Orthopaedics
基金
中国博士后科学基金面上资助(2017M610323)
江苏省博士后科研资助计划(1701018C)
江苏省自然科学基金青年基金(BK20170126).
