严重僵硬型脊柱畸形患者PVCR术后PJK的发生率及危险因素
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摘要
目的分析严重僵硬型脊柱畸形患者经后路全脊椎切除术(posterior vertebral column resection-PVCR术后近段交界性后凸(proximal junctional kyphosis-PJK)的发生率及危险因素。方法纳入2004年10月至2014年7月共86例,行PVCR治疗的严重僵硬型脊柱畸形患者,分析手术前、手术后3个月以及最近随访中获得的脊柱全长X片来评价PJK的发生情况,并用单因素回归分析方法分析了与PJK相关的10个危险因素,然后用多因素非条件Logistic回归分析方法分析PJK组与对照组之间差异有统计学意义的危险因素。结果 11例患者发生PJK。单因素比较的结果显示以下7个变量具差异有统计学意义(P <0.05):年龄(X2),切除椎体位置(X3),脊柱侧凸伴后凸畸形(X4),上端融合椎(X5),术前胸椎后凸(Pre-op TK)≥40°(X7),术前腰椎前凸≥60°(X8),病因(X10)。多因素非条件Logistic回归分析显示,X3 (OR=15.94),X4 (OR=12.10)和X7 (OR=10.39)与PJK独立相关。PJK组术前PI显着高于对照组(31.70°±4.30°vs 23.61°±2.72°,P=0.018)。与对照组相比,PJK组末次随访时LL值明显下降(△LL 9.73°±7.82°vs 2.81°±4.43°,P=0.013)。结论手术切除椎体的位置,脊柱侧凸伴后凸畸形,术前胸椎后凸TK≥40°是PVCR术后发生PJK的独立危险因素。术后腰椎骨盆的不匹配与PJK的发生有关。
Objective To investigate the incidence and risk factors of proximal junctional kyphosis related posterior vertebral column resection in severe and rigid spinal deformities.Me thods We analyzed 86 patients underwent PVCR between Oct. 2004 and July, 2013 in our department. Univariate analysis was used to identify the ten risk factors about clinical, radiographic and surgical features. Multi-factor unconditional logistic regression were used to identify the risk factors. Spinopelvic parameters were also analysed.Re s ults 11 patients were found with PJK. Univariate analysis showed that seven variables were statistically different(P< 0.05). Three factors showed statistical significant difference in multi-factor unconditional logistic regression research. The lumbar lodorsis decreased in early period and remained unchanged after 2 years fellow-up. Conclus ion Location of resected vertebrae, scoliosis with kyphosis, and PreOP-TK≥40°are independent risk factors for PJK following PVCR.Postoperative spinal-pelvic mismatch was related to PJK.
Objective To investigate the incidence and risk factors of proximal junctional kyphosis related posterior vertebral column resection in severe and rigid spinal deformities.Me thods We analyzed 86 patients underwent PVCR between Oct. 2004 and July, 2013 in our department. Univariate analysis was used to identify the ten risk factors about clinical, radiographic and surgical features. Multi-factor unconditional logistic regression were used to identify the risk factors. Spinopelvic parameters were also analysed.Re s ults 11 patients were found with PJK. Univariate analysis showed that seven variables were statistically different(P< 0.05). Three factors showed statistical significant difference in multi-factor unconditional logistic regression research. The lumbar lodorsis decreased in early period and remained unchanged after 2 years fellow-up. Conclus ion Location of resected vertebrae, scoliosis with kyphosis, and PreOP-TK≥40°are independent risk factors for PJK following PVCR.Postoperative spinal-pelvic mismatch was related to PJK.
引文
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[3] XIE J,WANG Y,ZHAO Z. Posterior vertebral column resection for correction of rigid spinal deformity curves more than 100 degrees[J]. Journal of Neurosurgery:Spine,2012,17(6):540-551.
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[8] KIM Y J,BRIDWELL K H,LENKE L G,et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion:minimum five-year follow-up[J]. Spine,2008,33(20):2179.
[9] KIM Y J,LENKE L G,BRIDWELL K H,et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3different types of posterior segmental spinal instrumentation and fusions:incidence and risk factor analysis of 410 cases[J]. Spine,2007,32(24):2731-2738.
[10] RHEE J M,BRIDWELL K H,WON D S,et al. Sagittal plane analysis of adolescent idiopathic scoliosis:the effect of anterior versus posterior instrumentation.,[J]. Spine,2002,27(21):2350.
[11]SCHAIRER W W,CARRER A,DEVIREN V,et al. Hospital readmission after spine fusion for adult spinal deformity[J]. Spine,2013,38(19):1681.
[12] XIE J,LI T,WANG Y,et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection(PVCR):a preliminary discussion of correction mechanisms of PVCR[J]. European Spine Journal,2012,21(4):705-710.
[13] HART R A,MCCARTHY I,AMES C P,et al. Proximal junctional kyphosis and proximal junctional failure[J].Neurosurgery Clinics of North America,2013,24(2):213-218.
[14]HART R,MCCARTHY I,OBRIEN M,et al. Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity[J]. Spine Journal,2013,38(19):1223-1227.
[15]XIE J M,ZHANG Y,WANG Y S,et al. The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities[J]. European Spine Journal,2014,23(1):149-156.
[16]SCHWAB F,LAFAGE V,PATEL A,et al. Sagittal plane considerations and the pelvis in the adult patient[J].Spine,2009,34(17):1828-1833.
[17] KIM Y J,BRIDWELL K H,LENKE L G,et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion:minimum five-year follow-up[J]. Spine,2008,33(20):2179.
[18] HELGESON M D,SHAH S A,NEWTON P O,et al. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw,hook,or hybrid instrumentation.[J]. Spine Journal,2010,7(5):51S-51S.
[19] BLONDEL B,WICKMAN A M,APAZIDIS A,et al. Selection of fusion levels in adults with spinal deformity:an update[J]. Spine Journal,2013,13(4):464-474.
[20] WATANABE K,LENKE L G,BRIDWELL K H,et al.Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs:analysis of morphological features[J]. Spine,2010,35(2):138-145.
[2] LENKE L G. Posterior vertebral column resection for severe pediatric deformity:minimum two-year follow-up of thirty-five consecutive patients[J].Spine,2009,34(20):2213-2221.
[3] XIE J,WANG Y,ZHAO Z. Posterior vertebral column resection for correction of rigid spinal deformity curves more than 100 degrees[J]. Journal of Neurosurgery:Spine,2012,17(6):540-551.
[4] GLATTES R C,BRIDWELL K H,LENKE L G,et al.Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion:incidence,outcomes,and risk factor analysis[J]. Spine,2005,30(14):1643-1649.
[5] DENIS F,SUN E C,WINTER R B. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis:minimum five-year follow-up[J]. Spine,2009,34(20):729-734.
[6] YAGI M,KING A B,BOACHIEADJEI 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,2012,36(1):1479-1489.
[7] MENDOZA-LATTES S,RIES Z,GAO Y,et al. Proximal junctional kyphosis in adult reconstructive spine surgery results from incomplete restoration of the lumbar lordosis relative to the magnitude of the thoracic kyphosis[J]. Iowa Orthopaedic Journal,2011,31(3):199.
[8] KIM Y J,BRIDWELL K H,LENKE L G,et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion:minimum five-year follow-up[J]. Spine,2008,33(20):2179.
[9] KIM Y J,LENKE L G,BRIDWELL K H,et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3different types of posterior segmental spinal instrumentation and fusions:incidence and risk factor analysis of 410 cases[J]. Spine,2007,32(24):2731-2738.
[10] RHEE J M,BRIDWELL K H,WON D S,et al. Sagittal plane analysis of adolescent idiopathic scoliosis:the effect of anterior versus posterior instrumentation.,[J]. Spine,2002,27(21):2350.
[11]SCHAIRER W W,CARRER A,DEVIREN V,et al. Hospital readmission after spine fusion for adult spinal deformity[J]. Spine,2013,38(19):1681.
[12] XIE J,LI T,WANG Y,et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection(PVCR):a preliminary discussion of correction mechanisms of PVCR[J]. European Spine Journal,2012,21(4):705-710.
[13] HART R A,MCCARTHY I,AMES C P,et al. Proximal junctional kyphosis and proximal junctional failure[J].Neurosurgery Clinics of North America,2013,24(2):213-218.
[14]HART R,MCCARTHY I,OBRIEN M,et al. Identification of decision criteria for revision surgery among patients with proximal junctional failure after surgical treatment of spinal deformity[J]. Spine Journal,2013,38(19):1223-1227.
[15]XIE J M,ZHANG Y,WANG Y S,et al. The risk factors of neurologic deficits of one-stage posterior vertebral column resection for patients with severe and rigid spinal deformities[J]. European Spine Journal,2014,23(1):149-156.
[16]SCHWAB F,LAFAGE V,PATEL A,et al. Sagittal plane considerations and the pelvis in the adult patient[J].Spine,2009,34(17):1828-1833.
[17] KIM Y J,BRIDWELL K H,LENKE L G,et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion:minimum five-year follow-up[J]. Spine,2008,33(20):2179.
[18] HELGESON M D,SHAH S A,NEWTON P O,et al. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw,hook,or hybrid instrumentation.[J]. Spine Journal,2010,7(5):51S-51S.
[19] BLONDEL B,WICKMAN A M,APAZIDIS A,et al. Selection of fusion levels in adults with spinal deformity:an update[J]. Spine Journal,2013,13(4):464-474.
[20] WATANABE K,LENKE L G,BRIDWELL K H,et al.Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs:analysis of morphological features[J]. Spine,2010,35(2):138-145.