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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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

Corresponding Authors: Yu Haiyang

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	Hu Xiaoming
	Yu Haiyang
	Zheng Guohui
	Zhang Wei
	Zhang Xu
	Chai Zihao
	Guan Yujun

Cite this article:

Hu Xiaoming,Yu Haiyang,Zheng Guohui, et al. Analysis of Risk Factors and Comparative Study of Life Quality of Proximal Junctional Kyphosis After Orthopedic Surgery of Old Thoracolumbar Fracture with Kyphosis[J]. sygkzz, 2022, 28(7): 577-583.

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http://www.sygkzz.com/EN/ OR http://www.sygkzz.com/EN/Y2022/V28/I7/577

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