卫星棒技术在脊柱三柱截骨矫形术后断棒翻修中的应用

Satellite rod technique around rod-breaking area in revision surgery after three-column osteotomy

目的评估围断棒区卫星棒技术在脊柱三柱截骨术后断棒翻修中的可行性及临床疗效。方法回顾性分析我院2012年12月至2015年3月应用卫星棒技术行脊柱三柱截骨术后断棒翻修术的11例患者病历，男7例，女4例，平均年龄27．3岁，翻修术后平均随访时间19．0个月。分别测量患者翻修术前、术后及末次随访时的侧凸Cobb角、最大后凸Cobb角（Nobal 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）。采用配对t检验比较患者术前、术后及末次随访时的Cobb角、冠状面和矢状面平衡变化情况。结果本组11例侧凸Cobb角翻修术前为38．40±21．1°，术后为32．0°±19．9°，平均矫正率为20．3％±14．4％；末次随访平均为31．4°±18．8°，未见矫正丢失；GK术前、术后分别为23．8°±24．8°、19．0°±22．1°，矫正率为23．7％±19．0％，末次随访时平均为19．8±20．1°，矫正维持良好；术前C7PL—CSVL平均为（19．0±19．7）mm，术后为（20．1±14．7）mm，差异无统计学意义，末次随访为（20．4±20．4）mm，无明显矫正丢失；SVA术前平均为（51．2±40．1）mm，术后即刻为（30．7±16．7）mm，末次随访为（29．7±19．6）mm，无明显矫正丢失。11例术后及随访中并未发现明显失代偿、矫正丢失及断棒等内固定失败的并发症发生。结论围断棒区卫星棒技术应用于脊柱三柱截骨术后断棒翻修患者可以减少手术创伤，获得坚强的内固定效果，恢复脊柱冠状面和矢状面平衡，且随访中脊柱平衡得到较好的维持。

Objective To evaluate the feasibility and clinical outcomes of satellite rod technique used around the rod- breaking area in the revision surgery due to rod fracture after three-column osteotomy. Methods 11 patients （7 males and 4 fe- males） applying satellite rod technique from December 2012 to March 2015 were retrospectively reviewed. The average age of the cohort was 27.3 years and the average duration of follow-up after revision surgery was 19.0 months. The coronal parameters includ- ing Cobb angle and distance between C7 plumb line and center sacral vertical line （C7PL-CSVL）, and the sagittal parameters including global kyphosis （GK） and sagittal vertical axis （SVA） were assessed at pre-revision, post-revision and last follow-up. The paired t test was used to analyze the difference among pre-operation, post-operation and last follow-up. Results The Cobb angles of pre-revision and post-revision were 38.4°±21.1 ° and 32.0°± 19.9°. The average correction rate was 20.3%± 14.4%. At last follow- up, the average Cobb angle was 31.4°± 18.8°, no significant loss of correction. Post-revision CTPL-CSVL changed from （19.0± 19.7） mm to （20.1±14.7） mm, of which the average value was （20.4±20.4） mm at last follow-up. The pre-revision and post-revision values of GK were 23.8°±24.8° and 19.0°±22.1° with the average correction rate being 23.7%±19.0%. At the last follow-up, the average GK was 19.8°±20.1° and the eorrection was well maintained. In terms of SVA, average （51.2±40.1） mm for pre-revision, （30.7± 16.7） mm for post-revision, and （29.7± 19.6） mm for last follow-up. In addition, there was no complication of implant failure during follow-up. Conclusion The satellite rod technique used around the rod-breaking area in the revision surgery due to rod fracture in patients undergoing three-column osteotomy could reduce surgical trauma, get rigid fixation, and rebuild coronal and sagittal balance. With the utilization of satellite rod technique, the coronal and sagittal balance could be well maintained during follow-up.