近端交界性后凸的危险因素分析

doi:10.3969/j.issn.1006-9771.2017.05.026

《中国康复理论与实践》 ›› 2017, Vol. 23 ›› Issue (5): 607-611.doi: 10.3969/j.issn.1006-9771.2017.05.026

近端交界性后凸的危险因素分析

郑波¹, 王飞², 张志成², 赵晓峰², 黄道余², 李放²

1.安徽医科大学北京军区总医院临床学院,安徽合肥市 230032;
2.北京军区总医院,北京市 100700。

收稿日期:2017-01-08 修回日期:2017-03-10 出版日期:2017-05-25 发布日期:2017-05-24
通讯作者: 李放。E-mail: Fangl6722@sina.com
作者简介:郑波(1988-),男,苗族,湖南沅陵县人,医师,主要研究方向：脊柱疾患的诊治。
基金资助:
全军医学科技青年培育项目(No.13QNP010)

Risk Factors for Proximal Junctional Kyphosis

ZHENG Bo¹, WANG Fei², ZHANG Zhi-cheng², ZHAO Xiao-feng², HUANG Dao-yu², LI Fang²

1. Beijing Military Region General Hospital Clinical College, Anhui Medical University, Hefei, Anhui 230032, China;
2. Beijing Military Region General Hospital, Beijing 100700, China

Received:2017-01-08 Revised:2017-03-10 Published:2017-05-25 Online:2017-05-24
Contact: LI Fang. E-mail: Fangl6722@sina.com

摘要/Abstract

摘要： 目的研究腰椎退行性疾病后路长节段固定融合术后近端交界性后凸(PJK)的危险因素。方法回顾性分析2012年10月至2014年7月因腰椎退行性疾病行后路长节段固定融合术患者118例,至少随访1.5年,在X线片上观察PJK的发生情况。结果共随访有完整资料的患者66例,平均随访3.2年,其中12例发生PJK (PJK组),其余为非PJK组。两组患者体质量指数、骨密度、末次随访Oswestry功能障碍指数评分有显著性差异(t>2.194, P<0.05)。两组患者上端固定椎位于胸腰段(T₁₁~L₁)的比率有显著性差异(χ²=4.63, P<0.05)。PJK组术前、术后及末次随访时PJK角显著大于非PJK组(t>3.862, P<0.001)。二元Logistic回归分析显示,骨质疏松(OR=5.328, 95% CI: 1.110~25.581)、上端固定椎位于胸腰段(OR=6.239, 95% CI: 1.157~33.648)、术前PJK角>10° (OR=5.789, 95% CI: 1.075~31.183)是发生PJK的危险因素。结论术前PJK角大于10°,上端固定椎位于胸腰段(T₁₁~L₁)及骨质疏松是腰椎长节段固定术后发生PJK的危险因素。

关键词: 腰椎退行性疾病, 近端交界性后凸, 后路长节段固定融合术, 危险因素

Abstract: Objective To investigate the risk factors of proximal junctional kyphosis (PJK) after posterior long segmental lumbar fusion for degenerative lumbar disease. Methods From October, 2012 to July, 2014, 118 degenerative lumbar disease patients who accepted posterior long segmental fusion and followed up at least 1.5 years were reviewed. All the PJK were evaluated with X-ray. Results Sixty-six patients completed the follow-up (mean of 3.2 years), in which 12 patients with PJK (PJK group), and the others without (non-PJK group, n=54). There was significant difference in body mass index, bone density and the last Oswestry Disability Index scores (t>2.194, P<0.05) between both groups, as well as the rate of the upper instrumented vertebra (UIV) located in the thoracolumbar segment (T₁₁-L₁) (χ²=4.63, P<0.05). The PJK angle was more in PJK group than non-PJK group pre-surgery, post-surgery and finally (t>3.862, P<0.001). Binary Logistic regression showed that osteoporosis (OR=5.328, 95% CI: 1.110~25.581), UIV located in the thoracolumbar segment (T₁₁-L₁) (OR=6.239, 95% CI: 1.157~33.648) and the pre-surgery PJK angle >10° (OR=5.789, 95% CI: 1.075~31.183) were the independent risk factors of PJK. Conclusion Osteoporosis, UIV located in the thoracolumbar segment (T₁₁-L₁) and the pre-surgery PJK angle >10° are risk factors of PJK after posterior long segmental lumbar fusion.

Key words: degenerative lumbar spinal disease, proximal junctional kyphosis, posterior long segmental lumbar fusion, risk factors

中图分类号:

R681.5

郑波, 王飞, 张志成, 赵晓峰, 黄道余, 李放. 近端交界性后凸的危险因素分析[J]. 《中国康复理论与实践》, 2017, 23(5): 607-611.

ZHENG Bo, WANG Fei, ZHANG Zhi-cheng, ZHAO Xiao-feng, HUANG Dao-yu, LI Fang. Risk Factors for Proximal Junctional Kyphosis[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(5): 607-611.

参考文献

[1] 李淳德. 脊柱内固定融合术在腰椎退变性疾病治疗中的作用[J]. 中华医学杂志, 2006, 86(25): 1734-1736.
[2] 毛路,沈忆新,王磊. 椎间盘源性下腰痛临床治疗研究[J]. 中国矫形外科杂志, 2007, 15(1): 39-41.
[3] Watanabe K, Lenke LG, Bridwell KH, et al. Proximal junctional vertebral fracture in adults after spinal deformity surgery using pedicle screw constructs: analysis of morphological features [J]. Spine (Phila Pa 1976), 2010, 35(2): 138-145.
[4] Kim YJ, Bridwell KH, Lenke LG, et al. Is the T 9 , T 11 , or L 1 the more reliable proximal level after adult lumbar or lumbosacral instrumented fusion to L 5 or S 1 ? [J]. Spine (Phila Pa 1976), 2007, 32(24): 2653-2661.
[5] Shufflebarger H, Suk SI, Mardjetko S. Debate: determining the upper instrumented vertebra in the management of adult degenerative scoliosis: stopping at T 10 versus L 1 [J]. Spine (Phila Pa 1976), 2006, 31(19 Suppl): S185-S194.
[6] Bridwell KH, Lenke LG, Cho SK, et al. Proximal junctional kyphosis in primary adult deformity surgery: evaluation of 20 degrees as a critical angle [J]. Neurosurgery, 2013, 72(6): 899-906.
[7] Yagi M, Akilah KB, Boachie-Adjei O. Incidence, risk factors and classification of proximal junctional kyphosis [J]. Spine, 2011, 36(1): E60-E68.
[8] Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity [J]. Spine, 2013, 38(23): E1469-E1476.
[9] Cammarata M, Aubin C, Wang X, et al. Biomechanical risk factors for proximal junctional kyphosis [J]. Spine, 2014, 39(8): E500-E507.
[10] O'Shaughnessy BA, Bridwell KH, Lenke LG, et al. Does a long-fusion "T 3 -sacrum" portend a worse outcome than a short-fusion "T 10 -sacrum" in primary surgery for adult scoliosis? [J]. Spine, 2012, 37(10): 884-890.
[11] Glattes RC, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis [J]. Spine (Phila Pa 1976), 2005, 30(14): 1643-1649.
[12] Yagi M, King AB, 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(17): 1479-1489.
[13] Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up [J]. Spine (Phila Pa 1976), 2008, 33(20): 2179-2184.
[14] Kim HJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis results in inferior SRS pain subscores in adult deformity patients [J]. Spine (Phila Pa 1976), 2013, 38(11): 896-901.
[15] Wang H, Ma L, Yang D, et al. Incidence and risk factors for the progression of proximal junctional kyphosis in degenerative lumbar scoliosis following long instrumented posterior spinal fusion [J]. Medicine (Baltimore), 2016, 95(32): e4443.
[16] Cho KJ, Suk SI, Park SR, et al. Selection of proximal fusion level for adult degenerative lumbar scoliosis [J]. Eur Spine J, 2013, 22(2): 394-401.
[17] Hart RA, Prendergast MA, Roberts WG, et al. Proximal junctional acute collapse cranial to multi-level lumbar fusion: a cost analysis of prophylactic vertebral augmentation [J]. Spine J, 2008, 8(6): 875-881.
[18] Kebaish KM, Martin CT, O'Brien JR, et al. Use of vertebroplasty to prevent proximal junctional fractures in adult deformity surgery: a biomechanical cadaveric study [J]. Spine J, 2013, 13(12): 1897-1903.

近端交界性后凸的危险因素分析

Risk Factors for Proximal Junctional Kyphosis

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	邓婷, 陈敬绵, 刘小蒙, 姚晓华, 刘芦姗, 何威, 张通, 芦海涛. 轻中度急性缺血性脑卒中并发卒中相关性肺炎的危险因素分析[J]. 《中国康复理论与实践》, 2023, 29(6): 708-713.
[2]	张雪茹,郝习君,李朝征,陈长香. 脑外伤患者认知功能障碍的危险因素[J]. 《中国康复理论与实践》, 2022, 28(2): 212-219.
[3]	孙宁,黄富表,叶婷. 青壮年脑卒中患者不良生活方式调查[J]. 《中国康复理论与实践》, 2022, 28(1): 24-31.
[4]	支金草,张世雯,黄美灵,裴飞,王艳. 导致儿童注意力缺陷多动障碍的孕期和围产期危险因素Scoping综述[J]. 《中国康复理论与实践》, 2022, 28(1): 79-89.
[5]	胡安明,王宇,孙炜. 神经外科康复单元脑外伤后脑积水发生危险因素分析[J]. 《中国康复理论与实践》, 2020, 26(9): 1083-1088.
[6]	高薇薇, 张晓晓, 白银婷. 宁波市养老院老年人吞咽功能障碍调查[J]. 《中国康复理论与实践》, 2019, 25(7): 761-765.
[7]	刘慧珍, 赵国伟, 李培兰, 商娜, 王娜, 刘芦姗. 脊髓损伤患者医院感染的临床特点及危险因素分析[J]. 《中国康复理论与实践》, 2019, 25(6): 664-669.
[8]	唐涛, 苟远涛, 唐俊, 何舰, 牟帅, 赵亮, 臧振峰, 徐练, 杨梅, 李燕. 成都地区成人股骨头坏死流行病学研究[J]. 《中国康复理论与实践》, 2018, 24(8): 970-974.
[9]	刘宏炜, 李军, 杜良杰. 肝癌膈下动脉化疗栓塞术致脊髓损伤康复治疗1例报道[J]. 《中国康复理论与实践》, 2018, 24(4): 472-476.
[10]	王娜，王丰容，刘芦姗. 急诊病房脑卒中相关性肺炎的危险因素及预后分析[J]. 《中国康复理论与实践》, 2017, 23(8): 932-936.
[11]	高钧，李雯，李晶. 脊髓损伤患者泌尿系感染常见危险因素及病原菌分布[J]. 《中国康复理论与实践》, 2017, 23(4): 420-423.
[12]	张伟, 陈立嘉, 张通. 大脑中动脉供血区梗死后失眠的危险因素分析[J]. 《中国康复理论与实践》, 2017, 23(1): 77-80.
[13]	王云霞，王会文，侯春梅，彭宇明，菅敏钰，张雪梅，房辉，韩如泉. 神经外科患者麻醉恢复期常见并发症及危险因素分析①[J]. 《中国康复理论与实践》, 2016, 22(8): 962-967.
[14]	吴章薇，赵军，李冰洁，梅利平，郭鸣，周昊. 心源性脑栓塞出血转化的危险因素及其与预后的关系①[J]. 《中国康复理论与实践》, 2016, 22(5): 559-562.
[15]	孙丹1，闫芳芳1，孟雨姗1，苑晓晓1，王雅莉1，盛嘉昭1，张伟宏1,2. 社区围绝经期女性心血管病发病危险评估①[J]. 《中国康复理论与实践》, 2016, 22(5): 593-595.