Lenke 5型青少年特发性脊柱侧弯患者术后近端交界性后凸与脊柱骨盆参数的相关性  

Correlation of PJK after TL/L posterior fusion and spinal-pelvic parameters in patients with Lenke type 5 AIS

作　　者：陈超[1] 崔赓[1] 宋凯[1] 苏晓静[1] 张恒[1] 齐鹏[1] 王征[1] CHEN Chao;CUI Geng;SONG Kai;SU Xiaojing;ZHANG Heng;QI Peng;WANG Zheng(Department of Orthopaedics,the First Medical Center,Chinese PLA General Hospital,Beijing,100853,China)

机构地区：[1]解放军总医院第一医学中心骨科

出　　处：《解放军医学院学报》2019年第6期548-553,共6页Academic Journal of Chinese PLA Medical School

摘　　要：目的分析影响Lenke 5型青少年特发性脊柱侧弯患者术后出现近端交界性后凸(proximal junctional kyphosis,PJK)的因素。方法回顾性分析2012年3月-2016年12月本中心脊柱外科收治的33例Lenke5型青少年特发性脊柱侧弯(adolescent idiopathic scoliosis,AIS)患者的临床资料。末次随访时近端交界角(proximal junctional angle,PJA)较术前增加>10°的患者纳入近端交界性后凸组(proximal junctional kyphosis,PJK),其他患者纳人非近端交界性后凸组(non-proximal junctional kyphosis,Non-PJK)。分析术前及末次随访时各参数的差异性,及PJA与各参数的相关性。结果本次研究中PJK组12人,男性3人,女性9人,平均年龄为13.58±3.2岁;Non-PJK组21人,男性5人,女性16人,平均年龄15.19±6.43岁。两组一般资料差异无统计学意义。PJK组TK、PJA、LL、LIF、PI-LL、TL/LC、TC,Non-PJK组TK、TLK、LIF、TL/LC、TC术前与末次随访时的差异有统计学意义;末次随访时PJK组与Nmi-PJK组TK、PJA、LL、PI-LL差异有统计学意义;末次随访时的PJA与TK(r=0.805,P=0.000)、TLK(r=0.397,P=0.022)、LUF(r=-0.357,P=0.042)、PI-LL(r=-0.528,P=0.002)、LL(r=-0.364,P=0.037)相关。结论术后TK、PI-LL过大可能是发生PJK的因素;可以通过术中减少TLK、根据PI将LL调整在合适的范围内防止术后PJK的出现。Objective To analyze the risk factors of proximal junctional kyphosis(PJK)after TL/L posterior fusion in patients with Lenke type 5 adolescent idiopathic scoliosis(AIS).Methods Clinical data about 33 patients with Lenke type 5 AIS admitted to our department from March 2012 to December 2016 were retrospectively analyzed.Patients with a increasement of PJA>10.after surgery were assigned to PJK group,while others were in non-PJK group.The differences in spinal radiographic parameters including thoracic kyphosis(TK),thoracolumbar kyphosis(TLK),proximal junctional angle(PJA),lumbar lordosis(LL),lordosis in fusion(LIF),lordosis under fusion(LUF),sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),thoracolumbar/lumbar curve(TL/LC),thoracic curve(TC),pelvic incidence minus lumbar lordosis(PI-LL),etc.at pre-operation and last follow-up were analyzed,and the relationship of these parameters with occurrence of PJK was explored.Results There were 12 patients in PJK group with 3 males and 9 females and average age of 13.58±3.2 years old.Twenty-one patients were in non-PJK group with 5 males and 16 females and average age of 15.19±6.43 years old.No statistically significant difference was found in general information of both groups.In PJK group,there were significant differences in TK,PJA,LL,LIF,PI-LL,TL/LC,TC before operation and at last follow-up.And TK,TLK,LIF,TL/LC,TC showed significant differences before operation and at last followup in non-PJK group.TK,PJA,LL,PI-LL of both groups were significantly different at last follow-up.PJK was correlated with TK(r=0.805,P=0.000),TLK(r=0.397,P=0.022),LUF(r=-0.357,P=0.042),PI-LL(r=-0.528,P=0.002),LL(r=-0.364,P=0.037)respectively at the last follow-up.Conclusion Greater postoperative TK and LL maybe the potential risk factors of PJK after TL/L posterior fusion in patients with Lenke type 5 AIS.Intraoperative moderately decreasing TLK and correcting LL according to PI may decrease the risk of PJK after surgery.

关 键 词：LENKE 5分型 青少年特发性脊柱侧弯 近端交界性后凸 

分 类 号：R687.3[医药卫生—骨科学]