强直性脊柱炎胸腰段后凸畸形矫形术后近端交界性后凸发生的临床因素分析及其预防  

Clinical influential factors and prevention measures of proximal junctional kyphosis after posterior osteotomy in ankylosing spondylitis with thoracolumbar kyphotic deformity

作　　者：王天昊[1,2] 赵永飞[2] 王征[2] 王岩[2] 

机构地区：[1]第三军医大学研究生管理大队,重庆400038 [2]解放军总医院骨科,北京100853

出　　处：《第三军医大学学报》2016年第10期1178-1182,共5页Journal of Third Military Medical University

摘　　要：目的探讨强直性脊柱炎(ankylosing spondylitis,AS)胸腰段后凸畸形矫形术后近端交界性后凸(proximal junctional kyphosis,PJK)的发生率、危险因素和预防方法。方法回顾性分析2007-2013年在解放军总医院行胸腰段截骨矫形手术的强直性脊柱炎患者,观察其矢状面参数及近端交界区后凸角度的变化,观察时间点包括术前、术后2周、术后6个月和末次随访。结果所有54例患者平均随访2年,其中4例(7.4%)发生近端交界性后凸。其余大部分病例在随访期间,近端交界区后凸角度均有增大趋势。在末次随访中,PJK组近端交界区后凸角度为(23.7°±4.3°),非PJK组为(10.4°±5.1°),两组比较差异有统计学意义(P<0.05)。两组患者术前胸椎后凸角度、术前近端交界区后凸角度及截骨角度比较,差异均有统计学意义(P<0.05)。结论强直性脊柱炎胸腰段后凸畸形矫形术后近端交界性后凸的发生率为7.4%,其相关危险因素包括术前TK较大,术前PJA大于10°以及矫形手术需较大的截骨角度。Objective To analyze the incidence,risk factors and prevention measures of proximal junctional kyphosis（ PJK） after surgical treatment for ankylosing spondylitis（ AS） with thoracolumbar kyphotic deformity. Methods A total of 54 patients with thoracolumbar kyphosis caused by AS underwent posterior osteotomy in Chinese PLA General Hospital during January 2007 and December 2009. Radiographic data before surgery,in 2 weeks and 6 months after surgery,and at the last follow-up were collected. The changes of proximal junctional angle（ PJA） and correlative sagittal factors were recorded. Results All patients were followed up with average time of 2 years. There were 7. 4% of patients（ 4 /54） developed into PJK,and almost every patient suffered PJA increasing. At the last follow-up,the PJA in the PJK group and the non-PJK group were 23. 7° ± 4. 3° and 10. 4° ± 5. 1°,respectively. There were significant differences in the pre-operative thoracic kyphosis（ TK）,PJA,and osteotomy angle between the 2 groups（ P 0. 05）.Conclusion The incidence of PJK is 7. 4% in the patients undergoing surgical treatment for AS with thoracolumbar kyphotic deformity. Risk factors of the PJK include the pre-operative TK,PJA 10 °,and osteotomy angle.

关 键 词：脊柱炎 强直性 脊柱后凸 矫形外科手术 近端交界性后凸 

分 类 号：R593.23[医药卫生—内科学] R682.3[医药卫生—临床医学]