特发性脊柱侧凸后路选择性腰弯矫形术后出现近端交界性后凸的临床研究  

Clinical study of proximal junctional kyphosis after selective lumbar fusion with posterior instrumentation in patients with idiopathic scoliosis

作　　者：李志钢[1] 宋建东[1] 李海东[1] 李长文[1] 李停[1] 吴恒[1] 

机构地区：[1]湖北省新华医院脊柱外科,武汉市430015

出　　处：《实用医学杂志》2012年第15期2531-2534,共4页The Journal of Practical Medicine

摘　　要：目的:探讨特发性脊柱侧凸后路选择性腰弯矫形内固定术后产生近端交界性脊柱后凸的原因。方法:回顾性分析2005年4月至2008年9月间21例采用后路选择性腰弯矫形术后患者,测量患者手术前后站立位矢状位腰椎前凸、骶骨倾斜角、骨盆投射角、融合节段近端交界区后凸角,同时对全部患者术后采用SRS-22问卷进行调查。其中PUMCⅠc型4例,PUMCⅡc1型7例,PUMCⅡd1型10例。全部病例随访18个月。结果:所有21例患者中,6例(28.6%)出现融合节段近端交界性后凸畸形(PJK)作为PJK组,而未发生者归为非PJK组。组间及组内比较采用t检验。发生PJK的6例患者手术前后腰椎前凸角比较差异有显著性,而非PJK组手术前后比较差异无显著性;PJK组和非PJK组手术前后骶骨倾斜角和骨盆投射角比较差异无显著性;PJK组与非PJK组手术前融合节段近端交界区后凸角比较差异有显著性,PJK组平均(9.42±3.53)°,其中3例术前交界区后凸角大于10°,非PJK组平均(3.27±1.66)°;两组患者术后SRS-22评分差异无显著性。结论:腰椎生理前凸改变及融合节段近端交界区后凸角较大可能是导致后路选择性腰弯矫形术后出现近端交界性后凸的原因,而骶骨倾斜角和骨盆倾斜角大小不是产生近端交界性后凸的主要原因。Objective To investigate the factors ofproximal junctional kyphosis after selective lumbar fusion with posterior approach in patients with idiopathic scoliosis. Methods From April 2005 to September 2008, 21 patients with idiopathic lumbar curve underwent selected spinal correction and bone graft fusion with posterior instrumentation. Lumbar lordosis （LL）, sacral slope （SS）, pelvic incidence （PI） and the sagittal Cobb＇ s angle at the proximal junction were surveyed in all the cases. And also all the patients were followed up for a 18 months. Results In all the cases, 6 cases developed proximal junctional kyphosis （PJK）. The 6 cases were regarded as PJK group. Others were as non-PJK group. In PJK group, LL changed significantly after the operation, and in non-PJK group, significant change of LL was not observed after the operation; neither PJK group nor non-PJK group, significant difference were found in SS and PI between pre- and postoperation; and about the sagittal Cobb＇s angle at the proximal junction in preoperation, significant difference was observed between PJK group and non-PJK group [（9.42 ± 3.53）° in PJK group, （3.27 ± 1.66）°in non-PJK group（P 〈 0.05） ]. There were no significant difference in SRS-22 score between the PJK group and the non-PJK group postoperation. Conclusion The change of lumbar lordosis and the bigger sagittal Cobb＇s angle at the proximal junction would be the main causes of proximal junctional kyphosis after selective lumbar fusion, and sacral slope and pelvic incidence were not the main causes.

关 键 词：脊柱侧凸 后路矫形 近端 交界性后凸 

分 类 号：R687.3[医药卫生—骨科学]