Extension of fusions to the pelvis in idiopathic scoliosis
Extension of fusions to the pelvis in idiopathic scoliosis
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DOI：
10.1097/00007632-200101150-00011
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发表时间：
2001-01-15
期刊：
影响因子：
3
通讯作者：
Ogilvie, JW
中科院分区：
文献类型：
--
作者：
Islam, NC;Wood, KB;Ogilvie, JW
研究设计：回顾性研究既往脊柱侧凸融合扩展至骨盆的患者。确定现代内固定和手术技术是否能提高融合率并减少并发症。背景资料总结。传统上，成人特发性脊柱侧凸患者的骨盆融合时间较长，导致包括假关节在内的并发症发生率较高。在手术后41个月（范围：24-116）审查了41名患者（40名女性，1名男性）的医院和诊所病历，以确定既往脊柱侧凸融合术是否延伸至骨盆。41例患者中有39例进行了前后融合延伸; 2例仅进行了后路延伸。41名患者中有37名使用Cotrel-Dubousset（CD）器械; 2名使用Isola（Acromed Corp.，Cleveland，OH），一个是TSRH;（Sofamor-Danek，孟菲斯，TN），一个是Synergy（Cross Medical Products，哥伦布，OH）。分析的参数包括融合率、矢状面和冠状面平衡、腰椎前凸、融合延伸长度和远端固定方法。41例患者中有30例出现并发症。假关节发生率为37%（15/41），与远端后路固定方法显著相关。单纯骶椎固定的发生率为53%（8/15），单纯髂骨固定的发生率为42%（3/7），骶髂联合固定的发生率为21%（4/19; P < 0.05）。这与融合率无关，融合延伸长度不影响假关节率和矢状面平衡。当固定在髂骨和骶骨上时，现代器械似乎能够保持矢状面平衡，并且当先前的脊柱侧凸融合延伸到骨盆时，假关节的发生率较低。并发症发生率仍然很高。
Study Design, Retrospective study of patients after extension of previous scoliosis fusions to the pelvis.Objective. To determine whether modern instrumentation and surgical techniques provide for increased fusion rates with fewer complications.Summary of Background Data. Traditionally, long fusions to the pelvis in adults with idiopathic scoliosis have resulted in high complication rates, including pseudarthrosis.Methods. The hospital and clinic charts of 41 patients (40 female, 1 male) were reviewed 41 months (range: 24-116) after surgery for extension to the pelvis of previous scoliosis fusions. Thirty-nine of 41 had a combined anteroposterior fusion extension; two had posterior extension only. In 37 of 41 patients, Cotrel-Dubousset (CD) instrumentation was used; in two, Isola (Acromed Corp., Cleveland, OH), in one, TSRH; (Sofamor-Danek, Memphis, TN), and in one, Synergy (Cross Medical Products, Columbus, OH). Parameters analyzed were fusion rate, sagittal and coronal balance, lumbar lordosis, length of fusion extension, and distal fixation method.Results. Complications were seen in 30 of 41 patients. The pseudarthrosis rate was 37% (15/41) and was significantly related to the method of distal posterior fixation. With sacral fixation only, the rate was 53% (8/15), with iliac fixation only 42% (3/7), and with both iliac and sacral fixation 21% (4/19; P < 0.05). This was not correlated with fusion rate, and the length of fusion extension did not affect the pseudarthrosis rate or sagittal balance.Conclusion. When fixed to the ilium and sacrum, modern instrumentation appears capable of maintaining sagittal balance with lower rates of pseudarthrosis when previous scoliosis fusions are extended to the pelvis. The complication rate remains significant.