成人脊柱畸形矫形术后胸腰段与下腰段最佳匹配度的研究  

An analysis on the optimal match between thoracolumbar kyphosis and lower lumbar lordosis in adult spinal deformity after long-fusion surgery

作　　者：张子方 王岩[2] 于涵 孟纯阳[1] 李念虎[3] 郑国权[2] Zhang Zifang;Wang Yan;Yu Han;Meng Chunyang;Li Nianhu;Zheng Guoquan(Department of Orthopaedics,Affiliated Hospital of Jining Medical University,Jining 272007,China;Department of Orthopaedics,the First Medical Center of Chinese PLA Gneral Hospital,Beijing 100853,China;Department of Orthopaedics,Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,China)

机构地区：[1]济宁医学院附属医院骨科,济宁272007 [2]解放军总医院第一医学中心骨科,北京100853 [3]山东中医药大学附属医院骨科,济南250014

出　　处：《中华骨科杂志》2023年第6期381-390,共10页Chinese Journal of Orthopaedics

基　　金：山东省老年医学学会重点项目(LKJGG2021Z009);山东省自然科学基金重点项目(ZR2020KH010)

摘　　要：目的探讨成人脊柱畸形(adult spinal deformity,ASD)患者矫形术后胸腰段后凸(thoracolumbar kyphosis,TLK)与下腰段前凸(lower lumbar lordosis,LLL)的最佳匹配度。方法回顾性分析2019年3月至2020年3月在济宁医学院附属医院(19例)、山东中医药大学附属医院(11例)和解放军总医院第一医学中心(89例)行后路胸腰椎固定融合术(固定椎体≥5个)的119例ASD患者资料,男28例、女91例,年龄(64.48±8.88)岁(范围45~79岁)。记录术后近端交界性失败、Oswestry功能障碍指数(Oswestry disability index,ODI)评分和脊柱侧凸研究学会-22项问卷(Scoliosis Research Society-22,SRS-22)评分。统计ODI改善率超过50%的患者例数,计算其术后早期胸腰椎匹配度(thoracolumbar match,TLM),根据95%CI临界值将患者分为三组。以受试者工作特征曲线(receiver operating characteristic curve,ROC)分析导致近端交界性失败的TLM,根据曲线下面积(area under the curve,AUC)得出TLM阈值。计算胸腰椎失配与近端交界性失败发生率的比值比(odds ratio,OR)。结果62例患者随访时间(51.68±15.60)个月(范围24~87个月)。末次随访时ODI改善率>50%,其TLM为0.41[95%CI(0.2,0.5)],根据临界值将119例患者分为三组:TLM<0.2组35例、0.2≤TLM≤0.5组48例和TLM>0.5组36例。TLM<0.2组术前TLK(13.87°±16.61°)及T_(1)骨盆角(19.69°±10.55°)最小,而TLM>0.5组最大(30.59°±16.68°,28.30°±14.46°)。术后1周,TLM<0.2组TLK最小(2.89°±1.78°)、TLM>0.5组最大(17.13°±12.13°);TLM>0.5组LLL最小(-26.16°±11.02°)。末次随访时,胸腰椎匹配组(0.2≤TLM≤0.5)患者ODI及SRS-22评分均优于胸腰椎失配组(TLM<0.2组和TLM>0.5组)。ROC曲线分析结果显示TLM最佳值为0.4[灵敏度为78.9%,特异度为76.2%;AUC为0.802,95%CI(0.708,0.896),P<0.001]。随访过程中有19例患者发生近端交界性失败,其中胸腰椎失配组16例(TLM<0.2组6例,TLM>0.5组10例)、匹配组(0.2≤TLM≤0.5组)3例,发生率分别为23%(16/71)和6%(3/48),�Objective To explore the optimal match degree between thoracolumbar kyphosis(TLK)and lower lumbar lordosis(LLL)in adult spinal deformity(ASD)after correction surgery.Methods Data of 119 ASD patients(male:28,female:91),belonging to the Affiliated Hospital of Jining Medical University(19 cases),the Affiliated Hospital of Shandong University of Traditional Chinese Medicine(11 cases),and the First Medical Center of Chinese PLA General Hospital(89 cases)were reviewed and documented from March 2019 to March 2020.All patients(age,64.48±8.88 years;range,45-79 years)underwent the surgical procedure of thoracolumbar fusion with instrumentations were followed up over 24 months(51.68±15.60 months;range,24-87 months)after surgery.Postoperative proximal interface failure,Oswestry disability index(ODI)score and Scoliosis Research Society-22(SRS-22)score were recorded for all patients.The immediate match of TLK to LLL postoperatively was calculated as follows:TLM=TLK/LLL.The data of those individuals with excellent improvements in the ODI(>50%)at the final follow-up were recorded and analyzed.Then the mean value and the 95%CI of TLM in those individuals were calculated.All participants were subdivided into three groups according to the 95%CI value of TLM.After the receiver operating characteristic curve(ROC)analyzing,the area under the ROC curve(AUC)was the best cutoff value of TLM.The association of proximal junctional failure(PJF)developing with the abnormal TLM postoperatively was analyzed with logistic regression,and the odds ratio(OR)was calculated.Results 62 patients had significant improvements in ODI(>50%)at the final follow-up,and the mean TLM in those individuals was 0.41[95%CI(0.2,0.5)].All patients were divided into three groups:TLM<0.2(35 cases),0.2≤TLM≤0.5(48 cases)and TLM>0.5(36 cases).The preoperative TLK(13.87°±16.61°)and T_(1) pelvic angle(19.69°±10.55°)in the those patients with TLM<0.2 were the smallest,and those were the largest in those with TLM>0.5(30.59°±16.68°,28.30°±14.46°).The individ

关 键 词：成年人 脊柱后凸 脊柱前凸 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]