退行性脊柱侧凸术后翻修原因及危险因素

The reasons and risk factors for revision surgery in degenerative scoliosis

目的：探讨退行性脊柱侧凸术后翻修的原因及相关危险因素。方法：回顾性研究2010年1月～2013年12月于我院手术治疗的132例退行性脊柱侧凸患者的临床及影像学资料，所有患者采用单一后路手术、融合范围5个椎体或以上、随访时间至少2年。其中男49例，女83例；年龄40～78岁，平均61.8±15岁。手术节段5～14个椎体，平均7.9±1.8个椎体。随访时间2～5年，平均3.7±1.2年。60例上位固定椎选择于T10或以上，72例选择于T10以下；69例下位固定椎选择于L5，63例选择于骶骨或髂骨；采用三柱截骨37例。统计翻修率，并分析不同翻修原因的危险因素。结果：132例中共15例17个并发症行翻修手术，翻修率11.4%。其中男5例，女10例；年龄41～75岁，平均59±17岁。翻修原因包括近端交界区并发症占29.4％（5/17），假关节形成或内置物断裂占23.5%（4/17），冠状位及矢状位失平衡各占11.8%（2/17），远端交界区并发症占11.8%（2/17），椎弓根螺钉误置、急性期深部创口感染各5.9%（1/17）。性别、年龄与翻修率无显著相关（χ2=0.104，P=0.747，χ2=0.151，P=0.698）；上位固定椎选择与近端交界区并发症无显著相关（χ2=0.063，P=0.802）；下位固定椎选择于骶骨或髂骨组的近端交界区并发症翻修率较L5组显著增加（χ2=2.033，P=0.041）；三柱截骨组棒断裂、冠状位失平衡较未行三柱截骨组显著增加（χ2=5.214，P=0.022）。结论：退行性脊柱侧凸术后翻修的主要原因包括近端交界区并发症、假关节形成或内置物断裂以及脊柱失平衡；三柱截骨会增加棒断裂及冠状位失平衡；融合至骶骨或髂骨会增加近端交界区并发症，

Objectives： To investigate the revision rate and the risk factors for revision surgery in degenerative scoliosis. Methods： 132 cases with degenerative scoliosis who underwent single posterior spinal fusion longer than 5 vertebrae and more than 2 years follow-up were studied retrospectively. There were 49 males and 83 females, the mean age was 61.8±15 years（40-78 years）. The fusion segments were 5-14 vertebrae（average, 7.9±1.8 vertebrae）. The mean follow-up was 3.7±1.2 years（2-5 years）. The clinical data and spinopelvic parameters were reviewed to identify the causes of revision surgery. Results： Revision surgeries were performed in 15 patients with 17 incidences of complications, with revision rate of 11.4%. There were 5 males and 10 females, the average age was 59±17 years（41-75 years）. The main reasons of revision surgery were proximal junctional complication（29.4%, 5/17）, pseudarthrosis or implant breakage（23.5%, 4/17）, and spinal coronal or sagittal imbalance（11.8% respectively）. There was no significant correlation between revision rate and age or gender（χ2=0.104, P=0.747, χ2=0.151, P=0.698）. There was also no significant correlation between revision rate of proximal junctional complication and upper instrumented vertebra（χ2=0.063, P=0.802）. However, the revision rate of proximal junctional complication with fusion to S1 group was more than that fusion to L5 group（χ2=2.033, P=0.041）. Moreover, there was a significant difference between three column osteotomy and non-three column osteotomy in terms of implant breakage and coronal imbalance（χ2=5.214,P=0.022）. Conclusions： The revision rate of degenerative scoliosis is 11.4%, and the main reasons are proximal junctional complication, pseudarthrosis or implant breakage and spinal imbalance. Three column osteotomy can cause implant breakage and coronal imbalance. Fusion to S1 can increase revision rate of proximal junctional complications.