成人退变性脊柱侧凸顶椎周围结构对上位固定节段骨折的影响研究  

The influence of periapical structure on upper instrumented vertebra fractures in adult degenerative scoliosis

作　　者：张彤童 孙祥耀 孙文志 胡海量[2] 孔超 鲁世保[2] ZHANG Tong-tong;SUN Xiang-yao;SUN Wen-zhi;HU Hai-liang;KONG Chao;LU Shi-bao(Department of Orthopedics,Chui Yang Liu Hospital Affiliated to Tsinghua University,Beijing,100022,China)

机构地区：[1]清华大学附属垂杨柳医院骨科,北京100022 [2]北京首都医科大学宣武医院骨科,北京100053

出　　处：《中国骨与关节杂志》2022年第5期366-373,共8页Chinese Journal of Bone and Joint

基　　金：国家自然基金面上项目(81672201,81871794);国家自然青年培育项目(QNPY2021018);北京市卫生和计划生育委员会“老年重大疾病关键技术研究”(PXM2017026283000002);北京市医院管理中心“青苗”计划专项经费资助(QML20210805);首都医科大学科研培育基金(H0608)。

摘　　要：目的评估“顶椎周围结构的平行四边形效应”预测上位固定节段(upper instrumented vertebra,UIV)骨折风险的有效性。方法对2016年1月至2018年1月期间接受治疗的成人退变性脊柱侧凸(adults degenerative scoliosis,ADS)患者进行回顾性分析。获取ADS患者的相关影像学数据:冠状面侧凸角(cobb angle,CA),矢状位垂直轴(sagittal vertical axis,SVA),胸腰段后凸角(thoracolumbar kyphosis,TLK),冠状位垂直轴(coronal vertical axis,CVA),骶骨倾斜角(sacral slope,SS),腰椎前凸角(lumbar lordosis,LL),骨盆投射角(pelvis incidence,PI),骨盆倾斜角(pelvis tilt,PT),不同顶椎周围椎间歇水平的腰椎多裂肌萎缩(lumbar multifidus atrophy,LMA)和关节突关节炎(facet joint osteoarthritis,FJOA)严重程度。按照有无UIV骨折,将患者分为UIV骨折组(F组)和无UIV骨折组(NF组),进行比较。采用线性回归分析比较“平行四边形效应”中各指标与影像学参数之间的关系。结果本研究中共纳入164例ADS患者。其中F组纳入38例,NF组纳入126例。末次随访的CA、TK、TLK、LL、PT、SS、PI-LL、CVA、SVA、Oswestry功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、疼痛视觉模拟评分(visual analogue scale,VAS)均较术前有明显改善(P<0.001)。F组凸侧U-LMA分级明显高于NF组(P=0.036)。F组的凸侧L-FJOA明显高于NF组(P=0.020)。凹侧U-LMA(P<0.001)、凸侧U-LMA(P=0.031)、凸侧L-LMA(P=0.026)、凹侧U-FJOA(P=0.003)、凹侧L-FJOA(P=0.004)为CA的保护性因素;凹侧L-LMA(P<0.001)为CA的危险因素。凹侧U-LMA(P=0.004)、凹侧U-FJOA(P=0.005)为CVA的危险因素;凸侧L-FJOA为CVA的保护性因素(P=0.007)。凸侧U-LMA为末次随访SVA的危险因素(P<0.001)。结论“平行四边形效应”对末次随访的CA、CVA以及SVA的预测作用较好。凸侧U-LMA或FJOA的严重程度明显增加,可能表明患者UIF的发生风险较高。Objective To retrospectively evaluate the“parallelogram effect on the periapical structure”in order to assess its effectiveness in predicting the risk of upper instrumented vertebra(UIV)fractures.Methods This study was a retrospective analysis of adults with degenerative scoliosis(ADS)who were treated between January 2016 and January 2018.Relevant imaging data of ADS patients:coronal cobb angle(CA),sagittal vertical axis(SVA),thoracolumbar kyphosis(TLK),coronal vertical axis(CVA),sacral slope(SS),lumbar lordosis(LL),pelvis incidence(PI),pelvis tilt(PT),lumbar multifidus atrophy(LMA)and facet joint osteoarthritis(FJOA)severity at different periapical intervertebral space levels.According to the presence or absence of UIV fracture,the patients were divided into the UIV fracture group(F group)and non-UIV fracture group(NF group)for comparison.Linear regression analysis was used to compare the relationship between each index and imaging parameters in“parallelogram effect”.Results A total of 164 ADS patients were included in this study.Among them,38 patients were included in the F group and 126 patients in the NF group.The CA,TK,TLK,LL,PT,SS,PI-LL,CVA,SVA,ODI,JOA and VAS scores at the last follow-up were significantly improved compared with those before operation(P<0.001).The U-LMA of convex side in F group was significantly higher than that in NF group(P=0.036).Convex L-FJOA in F group was significantly higher than that in NF group(P=0.020).Concave U-LMA(P<0.001),convex U-LMA(P=0.031),convex L-LMA(P=0.026),concave U-FJOA(P=0.003)and concave L-FJOA(P=0.004)were the protective factors of CA.Concave L-LMA(P<0.001)was a risk factor for CA.U-LMA of concave side(P=0.004)and U-FJOA of concave side(P=0.005)were risk factors for CVA.Convex L-FJOA was a protective factor for CVA(P=0.007).Convex U-LMA was a risk factor for SVA at the last follow-up(P<0.001).Conclusions The“parallelogram effect”has a good predictive effect on CA,CVA and SVA in the last follow-up.Significant increase in the severity of convex U-LMA or

关 键 词：脊柱侧凸 脊柱骨折 肌萎缩 骨关节炎 脊柱 

分 类 号：R682.3[医药卫生—骨科学]