胸腰椎术后远端交界性问题的研究进展  

Advance in the study of distal junctional problem after thoracolumbar surgery

作　　者：袁磊[1] 张心灵 曾岩[1] 杨晓曦 陈仲强[1] 李危石[1] Yuan Lei;Zhang Xinling;Zeng Yan;Yang Xiaoxi;Chen Zhongqiang;Li Weishi(Department of Orthopaedics,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院骨科,北京100191

出　　处：《中华骨科杂志》2020年第6期381-388,共8页Chinese Journal of Orthopaedics

基　　金：北京市自然基金(7202230)。

摘　　要：远端交界性问题(distal junctioanal problem,DJP)是脊柱矫形融合内固定术后严重的并发症。由于脊柱固定融合手术量逐年增加,术后发生远端交界性问题也随之上升。与近端交界性问题相比,远端交界性问题发生率低,但临床症状重,手术翻修率高。远端交界性问题包括远端交界性后凸和远端交界性失败。远端交界性后凸目前使用的定义较混乱,但最常用的是末次随访远端交界角>10°,并较术前增加10°。远端交界性失败有6种类型:腰椎前凸丢失、远端固定椎(lowest instrumented vertebra,LIV)下方椎间盘急性楔形变、LIV骨折、LIV远端椎体骨折、LIV内固定失败、固定远端发生椎管狭窄或不稳。发生DJP的可能危险因素大致分为个体因素、手术因素及影像学因素,包括:体重、年龄、脊柱畸形类型、骨质疏松、远端固定椎的选择不当、髋关节疾病、畸形位置、手术入路、手术切除范围过大、融合节段过短、不同内固定器械、LIV位于L5、下端固定至S1、不恰当的手术操作、术后脊柱序列恢复不佳等。DJP的发生率、危险因素、是否需要翻修以及翻修策略等存在一定的争议。本文对目前DJP的诊断标准、发生率、危险因素等研究进展进行的文献综述,旨在提高对远端交界性问题的认识。Distal junctional problem(DJP)is one of the severe complications after spinal correction,fixation and fusion.As the number of patients receiving spinal surgery increased recently,the incidence of DJP also increased dramatically.Compared with proximal junctional problem,the incidence of DJP is low.However,the clinical symptoms are severe,and the rate of surgical revision is high in patients with distal junctional problems.DJP include distal junctional kyphosis(DJK)and distal junctional failure(DJF).The definition of DJK is confusing,however,and the most commonly used was that the distal junction Angle at the last follow-up was greater than 10°and increased by 10°compared with that before surgery.There are 6 DJF modes:progressive loss of lumbar lordosis,acute wedging in the disc below the instrumentation,fracture of LIV,osteoporotic fracture below the long rigid fixation,failure of the instrumentation at LIV,spinal stenosis and or segmental instability underneath the instrumentation.Possible risk factors for DJP include weight,age,type of spinal deformity,osteoporosis,choice of LIV,hip disease,deformity location,surgical approach,surgical procedure,fusion segments,fixation devices,LIV at L5,fixed to S1 with no iliac screws,poor restoration of spinal alignment,et al.Currently,there are some controversies in DJP,mainly including the incidence,risk factors whether needs to and how to revise.The review intends to conduct a simple literature review of the current DJP diagnostic criteria,incidence,risk factors,and other research progress,in order to improve the understanding of the distal junction problem.

关 键 词：手术切除范围 椎管狭窄 交界性 脊柱畸形 手术入路 椎体骨折 末次随访 instrument 

分 类 号：R687[医药卫生—骨科学]