Significant investigation in the adult population has generated a body of research regarding proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) following long fusions to the sacrum and pelvis. However, much less is known regarding early complications, including PJK and PJF, in the ambulatory pediatric patient. As such, the objective of this study was to address the minimal literature on early complications after ambulatory pediatric patients underwent fusion to the sacrum with instrumentation to the pelvis in the era of sacral-alar-iliac (S2AI) instrumentation.

The authors performed a retrospective review of pediatric patients with nonidiopathic spinal deformity < 18 years of age with ambulatory capacity who underwent fusion to the pelvis at a multisurgeon pediatric academic spine practice from 2016 to 2018. All surgeries were posterior-only approaches with S2AI screws as the primary technique for sacropelvic fixation. Descriptive, outcome, and radiographic data were obtained. The definition of PJF included symptomatic PJK presenting as fracture, screw pullout, or disruption of the posterior osseoligamentous complex.

Twenty-five patients were included in this study. Nine patients (36.0%) had 15 complications for an overall complication rate of 60.0%. Unplanned return to the operating room occurred 8 times in 6 patients (24.0%). Four patients (16.0%) had wound issues (3 with deep wound infection and 1 with wound breakdown) requiring reoperation. Three patients (12.0%) had PJF, all requiring reoperation. A 16-year-old female patient with syndromic scoliosis underwent extension of fusion due to posterior tension band failure at 6 months. A 17-year-old male patient with neuromuscular scoliosis underwent extension of fusion due to proximal screw pullout at 5 months. A 10-year-old female patient with congenital scoliosis underwent extension for PJF at 5 months following posterior tension band failure. One patient had pseudarthrosis requiring reoperation 20 months postoperatively.

Fixation to the pelvis enables significant deformity correction, but with rather high rates of complications and unexpected returns to the operating room. Considerations of sagittal plane dynamics for PJK and PJF should be strongly analyzed when performing fixation to the pelvis in ambulatory pediatric patients.

对成年人群的重要调查已经产生了大量关于骶骨和骨盆长期融合后近端关节后凸畸形 (PJK) 和近端关节功能衰竭 (PJF) 的研究。然而，对门诊儿科患者的早期并发症（包括 PJK 和 PJF）知之甚少。因此，本研究的目的是解决在骶-翼-髂 (S2AI) 器械时代，门诊儿科患者接受骶骨融合术与骨盆器械融合后早期并发症的最少文献。

作者对 2016 年至 2018 年在多外科医生儿科学术脊柱实践中接受骨盆融合的 18 岁以下非特发性脊柱畸形儿科患者进行了回顾性研究。骶骨盆固定的主要技术。获得了描述性、结果和影像学数据。PJF 的定义包括有症状的 PJK，表现为骨折、螺钉拔出或后骨韧带复合体断裂。

本研究包括 25 名患者。9 名患者 (36.0%) 有 15 种并发症，总体并发症发生率为 60.0%。6 名患者（24.0%）发生了 8 次意外返回手术室。4 名患者 (16.0%) 有伤口问题（3 名有深部伤口感染，1 名有伤口破裂）需要再次手术。3 名患者 (12.0%) 患有 PJF，均需要再次手术。一名患有综合征性脊柱侧弯的 16 岁女性患者在 6 个月时因后张力带失效而接受了延长融合术。一名 17 岁男性神经肌肉性脊柱侧弯患者在 5 个月时因近端螺钉拔出而接受了延长融合术。一名患有先天性脊柱侧弯的 10 岁女性患者在后张力带失效后 5 个月时接受了 PJF 延长术。

固定在骨盆上可实现显着的畸形矫正，但并发症发生率相当高，而且意外返回手术室。在对非卧床儿童患者进行骨盆固定时，应充分考虑 PJK 和 PJF 的矢状面动力学。