成人脊柱侧凸矫形术后近端交界性后凸的影响因素分析
|
摘要
目的测量成人脊柱侧凸患者脊柱矢状位参数和骨盆参数,探讨矫形术后发生近端交界性后凸(PJK)的主要因素。方法回顾性分析2014年1月至2016年9月于我院接受手术治疗的45例成人脊柱侧凸患者的病例资料。根据近端交界角(PJA)是否>20°将患者分为PJK组和非PJK组。在脊柱正侧位X线片上测量两组患者术前、术后1周和末次随访时的胸椎后凸角(TK)、胸腰椎后凸角(TLK)、腰椎前凸角(LL)、矢状面躯干偏移(SVA)、骨盆投射角(PI)、骨盆倾斜角(PT)和骶骨倾斜角(SS)。采用logistic多元回归分析探讨成人脊柱侧凸矫形术后发生PJK的主要影响因素。结果 PJK组19例、非PJK组26例。两组患者在性别、年龄、随访时间、上端固定椎位置、下端固定椎位置方面差异均无统计学意义(P均>0.05)。PJK组患者末次随访时LL、末次随访时SVA、术前PT、末次随访时PT均大于非PJK组,术前SS、末次随访时SS均小于非PJK组,差异均有统计学意义(P均<0.05),其他参数在两组间差异均无统计学意义(P均>0.05)。Logistic多元回归分析显示,术前TK、末次随访时TK、末次随访时LL、末次随访时PT、术前SS是成人脊柱侧凸矫形术后发生PJK的主要影响因素(P均<0.05)。结论术前TK、末次随访时TK、末次随访时LL、末次随访时PT、术前SS是成人脊柱侧凸患者矫形术后发生PJK的主要影响因素。
Objective To measure the spinal sagittal parameters and pelvic parameters of adult scoliosis patients, and to explore the influencing factors of proximal junctional kyphosis(PJK) after surgery. Methods The clinical data of 45 adult scoliosis patients, who underwent surgical treatment in our hospital from Jan. 2014 to Sep. 2016, were retrospectively analyzed. The participants were divided into PJK group and non-PJK group according to whether proximal junctional angle(PJA) was >20°. Before operation,at 1 week after operation and at the last follow-up, the thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT) and sacral slope(SS) were measured and analyzed on the anteroposterior and lateral X-ray films of the spine. The main influencing factors of PJK in adult scoliosis patients after surgery were analyzed using logistic multivariate regression analysis. Results Nineteen patients were enrolled in the PJK group and 26 in the non-PJK group. There were no significant differences in the gender, age, followup time, upper instrumented vertebra or lower instrumented vertebra between the two groups(all P>0.05). Compared with the non-PJK group, the LL, SVA and PT at the last follow-up, and PT before operation were significantly larger in the PJK group, and the SS before operation and at the last follow-up were significantly lower(all P<0.05). However, there were no significant differences in the other parameters between the two groups(all P>0.05). Logistic multivariate regression analysis showed that TK and SS before operation, and TK, LL and PT at the last follow-up were the main in?uencing factors of PJK.Conclusion TK and SS before operation, and TK, LL and PT at the last follow-up are the main in?uencing factors of PJK.
Objective To measure the spinal sagittal parameters and pelvic parameters of adult scoliosis patients, and to explore the influencing factors of proximal junctional kyphosis(PJK) after surgery. Methods The clinical data of 45 adult scoliosis patients, who underwent surgical treatment in our hospital from Jan. 2014 to Sep. 2016, were retrospectively analyzed. The participants were divided into PJK group and non-PJK group according to whether proximal junctional angle(PJA) was >20°. Before operation,at 1 week after operation and at the last follow-up, the thoracic kyphosis(TK), thoracolumbar kyphosis(TLK), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT) and sacral slope(SS) were measured and analyzed on the anteroposterior and lateral X-ray films of the spine. The main influencing factors of PJK in adult scoliosis patients after surgery were analyzed using logistic multivariate regression analysis. Results Nineteen patients were enrolled in the PJK group and 26 in the non-PJK group. There were no significant differences in the gender, age, followup time, upper instrumented vertebra or lower instrumented vertebra between the two groups(all P>0.05). Compared with the non-PJK group, the LL, SVA and PT at the last follow-up, and PT before operation were significantly larger in the PJK group, and the SS before operation and at the last follow-up were significantly lower(all P<0.05). However, there were no significant differences in the other parameters between the two groups(all P>0.05). Logistic multivariate regression analysis showed that TK and SS before operation, and TK, LL and PT at the last follow-up were the main in?uencing factors of PJK.Conclusion TK and SS before operation, and TK, LL and PT at the last follow-up are the main in?uencing factors of PJK.
引文
[1]MARUO K,HA Y,INOUE S,SAMUEL S,OKADA E,HU S S,et al.Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity[J/OL].Spine(Phila Pa 1976),2013,38:E1469-E1476.doi:10.1097/BRS.0b013e3182a51d43.
[2]SMITH J S,SANSUR C A,DONALDSON W F 3rd,PERRA J H,MUDIYAM R,CHOMA T J,et al.Shortterm morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity:a report from the Scoliosis Research Society Morbidity and Mortality Committee[J].Spine(Phila Pa 1976),2011,36:958-964.
[3]HART R A,MCCARTHY I,AMES C P,SHAFFREYC I,HAMILTON D K,HOSTIN R.Proximal junctional kyphosis and proximal junctional failure[J].Neurosurg Clin N Am,2013,24:213-218.
[4]LOWE T G,KASTEN M D.An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann’s disease.Areview of 32 patients[J].Spine(Phila Pa 1976),1994,19:1680-1685.
[5]GLATTES R C,BRIDWELL K H,LENKE L G,KIM Y J,RINELLA A,EDWARDS C 2nd.Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion:incidence,outcomes,and risk factor analysis[J].Spine(Phila Pa1976),2005,30:1643-1649.
[6]BRIDWELL K H,LENKE L G,CHO S K,PAHYS J M,ZEBALA L P,DORWARD I G,et al.Proximal junctional kyphosis in primary adult deformity surgery:evaluation of 20 degrees as a critical angle[J].Neurosurgery,2013,72:899-906.
[7]SCHEER J K,FAKURNEJAD S,LAU D,DAUBS MD,COE J D,PAONESSA K J,et al.Results of the 2014SRS survey on PJK/PJF:a report on variation of select SRS member practice patterns,treatment indications,and opinions on classification development[J].Spine(Phila Pa 1976),2015,40:829-840.
[8]KIM H J,BRIDWELL K H,LENKE L G,PARK MS,SONG K S,PIYASKULKAEW C,et al.Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections[J/OL].Spine(Phila Pa 1976),2014,39:E576-E580.doi:10.1097/BRS.0000000000000246.
[9]DIEBO B G,SHAH N V,STROUD S G,PAULINO C B,SCHWAB F J,LAFAGE V.Realignment surgery in adult spinal deformity:prevalence and risk factors for proximal junctional kyphosis[J].Orthopade,2018,47:301-309.
[10]NICHOLLS F H,BAE J,THEOLOGIS A A,EKSI M S,AMES C P,BERVEN S H,et al.Factors associated with the development of and revision for proximal junctional kyphosis in 440 consecutive adult spinal deformity patients[J].Spine(Phila Pa 1976),2017,42:1693-1698.
[11]LONNER B S,REN Y,NEWTON P O,SHAH SA,SAMDANI A F,SHUFFLEBARGER H L,et al.Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis―the pelvis and other considerations[J].Spine Deform,2017,5:181-188.
[12]PARK S J,LEE C S,CHUNG S S,LEE J Y,KANG S S,PARK S H.Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity:survivorship analysis of 160 patients[J].Neurosurgery,2017,80:279-286.
[13]LAFAGE R,LINE B G,GUPTA S,LIABAUD B,SCHWAB F,SMITH J S,et al.Orientation of the upper-most instrumented segment influences proximal junctional disease following adult spinal deformity surgery[J].Spine(Phila Pa 1976),2017,42:1570-1577.
[14]NASTO L A,PEREZ-ROMERA A B,SHALABI S T,QURAISHI N A,MEHDIAN H.Correlation between preoperative spinopelvic alignment and risk of proximal junctional kyphosis after posterior-only surgical correction of Scheuermann kyphosis[J].Spine J,2016,16(4 Suppl):S26-S33.
[15]LAFAGE V,SCHWAB F,PATEL A,HAWKINSON N,FARCY J P.Pelvic tilt and truncal inclination:two key radiographic parameters in the setting of adults with spinal deformity[J/OL].Spine(Phila Pa 1976),2009,34:E599-E606.doi:10.1097/BRS.0b013e3181aad219.
[16]YAGI M,KING A B,BOACHIE-ADJEI O.Incidence,risk factors,and natural course of proximal junctional kyphosis:surgical outcomes review of adult idiopathic scoliosis.Minimum 5 years of follow-up[J].Spine(Phila Pa 1976),2012,37:1479-1489.
[17]YAGI M,FUJITA N,TSUJI O,NAGOSHI N,ASAZUMA T,ISHII K,et al.Low bone-mineral density is a significant risk for proximal junctional failure after surgical correction of adult spinal deformity:a propensity score-matched analysis[J].Spine(Phila Pa 1976),2018,43:485-491.
[18]CAMMARATA M,AUBIN Cé,WANG X,MACTHIONGJ M.Biomechanical risk factors for proximal junctional kyphosis:a detailed numerical analysis of surgical instrumentation variables[J/OL].Spine(Phila Pa 1976),2014,39:E500-E507.doi:10.1097/BRS.0000000000000222.
[2]SMITH J S,SANSUR C A,DONALDSON W F 3rd,PERRA J H,MUDIYAM R,CHOMA T J,et al.Shortterm morbidity and mortality associated with correction of thoracolumbar fixed sagittal plane deformity:a report from the Scoliosis Research Society Morbidity and Mortality Committee[J].Spine(Phila Pa 1976),2011,36:958-964.
[3]HART R A,MCCARTHY I,AMES C P,SHAFFREYC I,HAMILTON D K,HOSTIN R.Proximal junctional kyphosis and proximal junctional failure[J].Neurosurg Clin N Am,2013,24:213-218.
[4]LOWE T G,KASTEN M D.An analysis of sagittal curves and balance after Cotrel-Dubousset instrumentation for kyphosis secondary to Scheuermann’s disease.Areview of 32 patients[J].Spine(Phila Pa 1976),1994,19:1680-1685.
[5]GLATTES R C,BRIDWELL K H,LENKE L G,KIM Y J,RINELLA A,EDWARDS C 2nd.Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion:incidence,outcomes,and risk factor analysis[J].Spine(Phila Pa1976),2005,30:1643-1649.
[6]BRIDWELL K H,LENKE L G,CHO S K,PAHYS J M,ZEBALA L P,DORWARD I G,et al.Proximal junctional kyphosis in primary adult deformity surgery:evaluation of 20 degrees as a critical angle[J].Neurosurgery,2013,72:899-906.
[7]SCHEER J K,FAKURNEJAD S,LAU D,DAUBS MD,COE J D,PAONESSA K J,et al.Results of the 2014SRS survey on PJK/PJF:a report on variation of select SRS member practice patterns,treatment indications,and opinions on classification development[J].Spine(Phila Pa 1976),2015,40:829-840.
[8]KIM H J,BRIDWELL K H,LENKE L G,PARK MS,SONG K S,PIYASKULKAEW C,et al.Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections[J/OL].Spine(Phila Pa 1976),2014,39:E576-E580.doi:10.1097/BRS.0000000000000246.
[9]DIEBO B G,SHAH N V,STROUD S G,PAULINO C B,SCHWAB F J,LAFAGE V.Realignment surgery in adult spinal deformity:prevalence and risk factors for proximal junctional kyphosis[J].Orthopade,2018,47:301-309.
[10]NICHOLLS F H,BAE J,THEOLOGIS A A,EKSI M S,AMES C P,BERVEN S H,et al.Factors associated with the development of and revision for proximal junctional kyphosis in 440 consecutive adult spinal deformity patients[J].Spine(Phila Pa 1976),2017,42:1693-1698.
[11]LONNER B S,REN Y,NEWTON P O,SHAH SA,SAMDANI A F,SHUFFLEBARGER H L,et al.Risk factors of proximal junctional kyphosis in adolescent idiopathic scoliosis―the pelvis and other considerations[J].Spine Deform,2017,5:181-188.
[12]PARK S J,LEE C S,CHUNG S S,LEE J Y,KANG S S,PARK S H.Different risk factors of proximal junctional kyphosis and proximal junctional failure following long instrumented fusion to the sacrum for adult spinal deformity:survivorship analysis of 160 patients[J].Neurosurgery,2017,80:279-286.
[13]LAFAGE R,LINE B G,GUPTA S,LIABAUD B,SCHWAB F,SMITH J S,et al.Orientation of the upper-most instrumented segment influences proximal junctional disease following adult spinal deformity surgery[J].Spine(Phila Pa 1976),2017,42:1570-1577.
[14]NASTO L A,PEREZ-ROMERA A B,SHALABI S T,QURAISHI N A,MEHDIAN H.Correlation between preoperative spinopelvic alignment and risk of proximal junctional kyphosis after posterior-only surgical correction of Scheuermann kyphosis[J].Spine J,2016,16(4 Suppl):S26-S33.
[15]LAFAGE V,SCHWAB F,PATEL A,HAWKINSON N,FARCY J P.Pelvic tilt and truncal inclination:two key radiographic parameters in the setting of adults with spinal deformity[J/OL].Spine(Phila Pa 1976),2009,34:E599-E606.doi:10.1097/BRS.0b013e3181aad219.
[16]YAGI M,KING A B,BOACHIE-ADJEI O.Incidence,risk factors,and natural course of proximal junctional kyphosis:surgical outcomes review of adult idiopathic scoliosis.Minimum 5 years of follow-up[J].Spine(Phila Pa 1976),2012,37:1479-1489.
[17]YAGI M,FUJITA N,TSUJI O,NAGOSHI N,ASAZUMA T,ISHII K,et al.Low bone-mineral density is a significant risk for proximal junctional failure after surgical correction of adult spinal deformity:a propensity score-matched analysis[J].Spine(Phila Pa 1976),2018,43:485-491.
[18]CAMMARATA M,AUBIN Cé,WANG X,MACTHIONGJ M.Biomechanical risk factors for proximal junctional kyphosis:a detailed numerical analysis of surgical instrumentation variables[J/OL].Spine(Phila Pa 1976),2014,39:E500-E507.doi:10.1097/BRS.0000000000000222.