陈旧性胸腰椎骨折后凸畸形术后近端交界性后凸发生的危险因素及生活质量研究

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摘要目的探讨分析陈旧性胸腰椎骨折伴后凸畸形患者矫形术后发生近端交界性后凸(proximal junctional kyphosis，PJK)的危险因素及生活质量。方法回顾性分析2017年1月至2020年8月于安徽医科大学附属阜阳人民医院行后路截骨长节段融合固定矫形手术治疗且具有完整临床及影像学资料的41例陈旧性胸腰椎骨折伴后凸畸形(经MRI证实为陈旧性骨折)患者资料，其中男7例，女34例；年龄45~77岁，平均年龄(62.2±9.5)岁。随访记录患者身体质量指数(body mass index，BMI)、融合节段、最上端固定椎(upper instrumented vertebra，UIV)的位置，使用国际脊柱侧凸研究学会22项问卷量表(scoliosis research society-22，SRS-22)评估患者生活质量。测量患者术前、术后即刻、术后6个月及末次随访时的近端交界角(proximal junctional angle，PJA)、骨盆入射角(pelvic incidence，PI)、骨盆投射角(pelvic tilt，PT)、骶骨倾斜角(sacral slope，SS)、矢状面平衡(sagittal vertical axis，SVA)、胸椎后凸角(thoracic kyphosis，TK)、腰椎前凸角(lumbar lordosis，LL)、局部后凸角(local kyphosis cobb angle，LKCA)、脊柱后凸柔韧性(spinal flexibility，SF)。依据患者术后是否发生PJK将患者分为PJK组和非PJK组。采用独立样本t检验、χ²检验或Fisher确切概率法对比PJK组与非PJK组临床、随访及影像学资料，利用Logistic回归分析确定PJK发生的危险因素。结果 41例患者术后平均随访(28.2±13.3)个月，其中9例(22.0%)发生PJK，5例发生于术后6个月内。PJK组术前PJA为(3.7±4.0)°，术后6个月为(12.3±5.9)°，末次随访时为(18.9±6.2)°。两组患者年龄、性别、随访时间、BMI、融合节段、UIV位置差异均无统计学意义(P＞0.05)。两组患者术后6个月及末次随访时PJA、末次随访时TK及术前LKCA差异均有统计学意义(P＜0.05)，其余影像学数据差异均无统计学意义(P＞0.05)。回归分析结果显示LKCA矫正过大(>35°)是PJK发生的危险因素。至末次随访时两组患者SRS-22评分结果差异无统计学意义(P＞0.05)。结论本研究陈旧性胸腰椎骨折伴后凸畸形矫形术后近端交界性后凸的发生率为22.0%(9/41)，局部后凸角矫正过大是发生PJK的危险因素。PJK患者在生活质量上与非PJK患者相比并无显著差异。

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关键词 ：陈旧性胸腰椎骨折, 脊柱后凸, 近端交界性后凸, 生活质量, 矢状位平衡

Abstract：Objective To explore the risk factors and life quality of proximal junctional kyphosis(PJK) in patients with old thoracolumbar fracture with kyphosis after orthopedic surgery.Methods From January 2017 to August 2020，41 patients with old thoracolumbar fracture with kyphosis of Fuyang People’s Hospital of Anhui Medical University were retrospectively analyzed，including 7 males and 34 females.The patients underwent posterior osteotomy and long segment fusion and orthopedic surgery and had complete clinical and imaging data.The age ranged from 45~77 years old，with an average age of (62.2±9.5)years.The body mass index(BMI)，fusion segment and the position of the upper instrumented vertebra(UIV)were recorded，and the quality of life of the patients was evaluated by the scoliosis research society 22 scale(SRS-22).The proximal junctional angle(PJA)，pelvic incidence(PI)，pelvic tilt(PT)，sacral slope(SS)，sagittal vertical axis(SVA)，thoracic kyphosis(TK)，lumbar lordosis(LL) and local kyphosis cobb angle(LKCA)，spinal flexibility(SF) were measured before and after surgery and at last follow-up.According to the occurrence of PJK after operation，the patients were divided into PJK group and non-PJK group.The data of PJK group and nonPJK group were compared by independent sample t-test，χ²test or Fisher exact probability method.Results 41 patients were followed up for(28.2±13.3)months，during which PJK occured in 9 cases(22.0%).5 cases occurred within 6 months after operation.In PJK group，the PJA was (3.7±4.0)° before operation，(12.3±5.9)° 6 months after operation，and (18.9±6.2)° at the last follow-up.There was no significant difference in age，sex，follow-up time，BMI，fusion segment and UIV position between PJK group and non-PJK group.There were significant differences in PJA，TK and preoperative LKCA between the two groups at 6 months after operation and at the last follow-up，while there was no significant difference in other imaging data (P＞0.05).The results of logistic regression analysis showed that excessive LKCA correction (>35°) was a risk factor for the occurrence of PJK.At the last follow-up，there was no significant difference in SRS-22 score between the two groups (P＞0.05).Conclusion The incidence of proximal junctional kyphosis after orthopedic correction of old thoracolumbar fracture with kyphosis was 22.0%.Excessive correction of local kyphosis cobb angle is a risk factor for PJK.There was no significant difference in life quality between PJK patients and non-PJK patients.

Key words： old thoracolumbar fracture spinal kyphosis proximal junctional kyphosis life quality sagittal balance

基金资助:2021年度安徽省卫生健康委科研项目(AHWJ2021b111)
安徽医科大学校科研基金资助项目(2021xkj210)
2019年阜阳市卫健委科研课题(FY2019-19)

通讯作者: 于海洋

作者简介: 胡晓明(1997－ )，男，研究生在读，安徽医科大学阜阳临床学院，892154219@qq.com。

引用本文:

胡晓明，于海洋，郑国辉，张伟，张旭，柴子豪，管俞君. 陈旧性胸腰椎骨折后凸畸形术后近端交界性后凸发生的危险因素及生活质量研究[J]. 实用骨科杂志, 2022, 28(7): 577-583.
Hu Xiaoming，Yu Haiyang，Zheng Guohui，Zhang Wei，Zhang Xu，Chai Zihao，Guan Yujun. Analysis of Risk Factors and Comparative Study of Life Quality of Proximal Junctional Kyphosis After Orthopedic Surgery of Old Thoracolumbar Fracture with Kyphosis. sygkzz, 2022, 28(7): 577-583.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2022/V28/I7/577

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