老年脊柱术后胸腰段近端交界性后凸的矢状位参数分析  

Analysis of sagittal parameters about senior thoracolumbar proximal junctional kyphosis after lumbar long segment fusion

作　　者：赵耀[1] 李淳德[1] 刘宪义[1] 邑晓东[1] 刘宏[1] 卢海霖[1] 李宏[1] 于峥嵘[1] 孙浩林[1] 王诗军[1] 

机构地区：[1]北京大学第一医院骨科,北京100034

出　　处：《北京大学学报（医学版）》2013年第5期732-737,共6页Journal of Peking University:Health Sciences

摘　　要：目的:探讨老年患者行腰椎长节段融合术后,发生胸腰段近端交界性后凸(proximal junctional kyphosis,PJK)的危险因素。方法:PJK组选取2009年1月至2011年12月间、年龄≥60岁、行腰椎长节段(≥4节)后路融合手术、最上端固定椎位于L1或L2、随访出现近端交界性后凸的患者共9例。对照组选取满足相同条件、随访时间达2年、无PJK的患者10例。于脊柱全长侧位片测量颈7椎体偏移距离(sagittal vertical axis,SVA)、胸椎后凸(thoracic kyphosis,TK)、腰椎前凸(lumbar lordosis,LL)、上端固定椎体倾斜角(upper instrumented vertebral angle,UIVA)、骨盆投射角(pelvic incidence,PI)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜度(pelvic tilt,PT)及腰椎骨盆前凸角(pelvic radius-T12,PR-T12)等矢状位参数。记录两组末次随访时的Oswestry功能障碍指数(the oswestry disability index,ODI)评分,比较两组之间的差异。结果:PJK现象出现的平均时间为术后7.9个月。胸腰段出现PJK,患者腰椎前凸显著减小,并出现明显的骨盆后倾代偿。与对照组相比,PJK组术后重建的腰椎前凸、PR-T12较小,上端固定椎体后仰度数小,腰椎骨盆失衡较重。PJK组与对照组的ODI评分分别为40.6±15.9和21.5±15.0,差异有统计学意义。结论:老年患者行腰椎长节段后路融合术后出现PJK现象会加重整体矢状位的失平衡,并明显影响患者的生活质量。为了减少胸腰段PJK的发生率,手术时应重视对脊柱-骨盆平衡的纠正,构建协调的脊柱曲线。Objective： To explore the radiographic risk factors of senior thoracolumbar proximal junc- tional kypbosis （PJK） after lumbar long segment fusion. Methods： From January 2009 to December 2011, the PJK group enrolled 9 patients who satisfied the following criteria： being older than 60 years, having lumbar fusion operation no less than 4 levels, upper instrumented vertebrae being L1 or L2, emer- ging PJK in 2-year follow-up, and the control group enrolled 10 matched patients without PJK. Their sa- gittal parameters including sagittal vertical axis, thoracic kyphosis, lumbar lordosis, upper instrumented vertebral angle, pelvic incidence, sacral slope, pelvic tilt, lumbo-pelvic lordosis on full length spine la- teral film were measured, the oswestry disability index （ ODI ） scores of the two groups in the last follow up recorded, and the parameters and ODI scores of two groups compared. Results： The phenomena of PJK emerged average 7.9 months post-operation. The patients＇ lumbar lordosis reduced and compensato- ry pelvic appeared backward obviously after PJK emerged. Compared with the control group, lumbar lor- dosis, pelvic radius-T12 （PR-T12） , upper instrumented vertebral angle were small in the PJK group, suggesting more severe lumbar pelvic imbalance. The ODI scores of the PJK group and contral group were 40.6 ± 15.9 and 21.5 ± 15.0 respectively, and the difference was significant. Conclusion： PJK after lumbar long segment fixation of elderly patients can aggravate the sagittal imbalance and reduce functional scores. The operator should pay great attention to restorin~ the lumbo-Delvic lordosis.

关 键 词：脊柱疾病 手术后并发症 脊柱融合术 脊柱后凸 老年人 

分 类 号：R681.53[医药卫生—骨科学]