严重僵硬型脊柱畸形患者PVCR术后PJK的发生率及危险因素  

Proximal Junctional Kyphosis Related Posterior Vertebral Column Resection in Severe and Rigid Spinal Deformities

作　　者：张颖[1] 王迎松[1] 解京明[1] 赵智[1] 李韬[1] 毕尼[1] ZHANG Ying;WANG Ying-song;XIE Jing-ming;ZHAO Zhi;LI Tao;BI Ni(Dept.of Orthipedics,The 2nd Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650101,China)

机构地区：[1]昆明医科大学第二附属医院骨科,云南昆明650101

出　　处：《昆明医科大学学报》2019年第1期58-64,共7页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(2015FB053)

摘　　要：目的分析严重僵硬型脊柱畸形患者经后路全脊椎切除术(posterior vertebral column resection-PVCR术后近段交界性后凸(proximal junctional kyphosis-PJK)的发生率及危险因素。方法纳入2004年10月至2014年7月共86例,行PVCR治疗的严重僵硬型脊柱畸形患者,分析手术前、手术后3个月以及最近随访中获得的脊柱全长X片来评价PJK的发生情况,并用单因素回归分析方法分析了与PJK相关的10个危险因素,然后用多因素非条件Logistic回归分析方法分析PJK组与对照组之间差异有统计学意义的危险因素。结果 11例患者发生PJK。单因素比较的结果显示以下7个变量具差异有统计学意义(P <0.05):年龄(X2),切除椎体位置(X3),脊柱侧凸伴后凸畸形(X4),上端融合椎(X5),术前胸椎后凸(Pre-op TK)≥40°(X7),术前腰椎前凸≥60°(X8),病因(X10)。多因素非条件Logistic回归分析显示,X3 (OR=15.94),X4 (OR=12.10)和X7 (OR=10.39)与PJK独立相关。PJK组术前PI显着高于对照组(31.70°±4.30°vs 23.61°±2.72°,P=0.018)。与对照组相比,PJK组末次随访时LL值明显下降(△LL 9.73°±7.82°vs 2.81°±4.43°,P=0.013)。结论手术切除椎体的位置,脊柱侧凸伴后凸畸形,术前胸椎后凸TK≥40°是PVCR术后发生PJK的独立危险因素。术后腰椎骨盆的不匹配与PJK的发生有关。Objective To investigate the incidence and risk factors of proximal junctional kyphosis related posterior vertebral column resection in severe and rigid spinal deformities.Methods We analyzed 86 patients underwent PVCR between Oct.2004 and July,2013 in our department.Univariate analysis was used to identify the ten risk factors about clinical,radiographic and surgical features.Multi-factor unconditional logistic regression were used to identify the risk factors.Spinopelvic parameters were also analysed.Results 11 patients were found with PJK.Univariate analysis showed that seven variables were statistically different(P<0.05).Three factors showed statistical significant difference in multi-factor unconditional logistic regression research.The lumbar lodorsis decreased in early period and remained unchanged after 2 years fellow-up.Conclusion Location of resected vertebrae,scoliosis with kyphosis,and PreOP-TK≥40°are independent risk factors for PJK following PVCR.Postoperative spinal-pelvic mismatch was related to PJK.

关 键 词：脊柱畸形 椎体全切 危险因素 脊柱骨盆力线 

分 类 号：R4[医药卫生—临床医学]