一种有效而安全的手术技术挽救儿童患者术后近端连接功能衰竭-一个病例系列

Mason A. Fawcett, R. Schwend
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摘要

背景:近端连接失败(PJF)是后路脊柱融合术后已知的并发症,可以简单地定义为需要手术翻修近端内固定的近端连接后凸。PJF可能与疼痛、神经功能下降、感染和发病率增加有关。关于儿童的这一主题的文献很少,特别是关于翻修手术的具体手术技术。方法:翻修技术包括用配对的椎板下带作为锚点近端扩展脊柱内固定。通常需要在后凸水平处进行后路截骨术。束带逐渐依次收紧,使脊柱进入矫正后的矢状位。接受该手术并进行至少1年随访的患者被确定。在手术前和最近的随访中分析了人口统计学和临床数据,以及平片和CT矢状脊柱参数。结果:8例患儿纳入研究,平均年龄14岁10个月,平均随访时间31个月。翻修手术在初次手术后大约3年进行。使用平均6条板下带,在失败部位平均进行20度(从增加18度到减少46度)后凸角矫正,平均进行16度(从增加24度到减少78度)颈椎前凸矫正。翻修前,所有患者均报告颈部/上背部疼痛,并伴有上棒突出。在最近一次翻修后的随访中,疼痛明显减轻,骨棒突出也得到了解决。一名患者表示对外表的满意度增加了,另一名患者指出,保持水平凝视更容易。结论:接受该手术治疗PJF的儿童疼痛和上棒突出得到缓解,颈椎矢状位影像学参数得到改善,并在翻修手术后至少维持1年。
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An Effective and Safe Surgical Technique for Salvage of Postoperative Proximal Junctional Failure in Pediatric Patients—A Case Series
Background: Proximal junctional failure (PJF) is a known complication following posterior spinal fusion surgery and can be defined simply as proximal junctional kyphosis that requires surgical revision of the proximal instrumentation. PJF can be associated with pain, decreased neurologic function, infection, and increased morbidity. There is little literature on this topic in children and especially on specific surgical techniques for revision surgery. Methods: The revision technique involves extending the spine instrumentation proximally with paired sets of sublaminar bands used as anchors. Posterior osteotomies are typically required at the level of the kyphosis. The bands are gradually and sequentially tightened, bringing the spine into a corrected sagittal position. Patients who underwent this procedure and had at least 1 year of follow-up were identified. Demographic and clinical data, as well as plain radiographic and CT sagittal spine parameters, were analyzed before the surgery and at the most recent follow-up. Results: Eight children, average age 14 years, 10 months, were included in the study with an average follow-up time of 31 months. Revision surgery occurred approximately 3 years following the initial surgery. There was 20 degrees (ranging from an increase of 18° to a decrease of 46 degrees) mean kyphotic angle correction at the site of the failure and 16 degrees (ranging from an increase of 24 degrees to a decrease of 78 degrees) mean cervical lordosis correction, using an average of 6 sublaminar bands. Before revision, all patients reported neck/upper back pain, with upper rod prominence. At the most recent post-revision visit, pain was markedly reduced, and rod prominence had resolved. One patient reported increased satisfaction with appearance, and another noted that maintaining horizontal gaze was easier. Conclusion: Children who received this surgical technique for their PJF experienced resolution of pain and upper rod prominence and improved cervical spine sagittal radiographic parameters that was maintained at least 1 year after revision surgery.
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