合并骨质疏松症的脊柱畸形长节段融合术后近端交界性后凸的危险因素  

Risk factors for proximal junctional kyphosis in adult spinal deformity patients with concurrent osteoporosis undergoing long-segment spinal fusion surgery

作　　者：杨宏浩 李章富 张瀚文 张希诺[1] 海涌[1] Yang Honghao;Li Zhangfu;Zhang Hanwen;Zhang Xinuo;Hai Yong(Department of Orthopaedics,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院骨科,北京100020

出　　处：《中华骨科杂志》2024年第11期740-747,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨合并骨质疏松症的脊柱畸形长节段融合术后近端交界性后凸(proximal junctional kyphosis,PJK)的危险因素。方法回顾性分析2013年6月至2019年12月在北京朝阳医院骨科接受长节段脊柱融合术的骨质疏松性脊柱畸形患者76例,男19例、女57例,年龄(66.26±6.10)岁(范围54~78岁)。根据术后2年随访期间是否发生PJK分组,其中PJK组21例、非PJK组55例。对比两组患者临床资料、术前及术后脊柱骨盆参数、椎体亨氏单位(Hounsfield Unit,HU)值及椎旁肌形态。脊柱骨盆参数包括主弯Cobb角、腰椎前凸(lumbar lordosis,LL)、腰骶椎前凸(lumbosacral lordosis,LSL)、矢状面轴向距离(sagittal vertical axis,SVA)、T1骨盆角(T1 pelvic angle,TPA)、骨盆倾斜度(pelvic tilt,PT)、骶骨倾斜角(sacral slope,SS)、骨盆入射角(pelvic incidence,PI)。通过术前CT分别测量上端固定椎(upper instrumented vertebra,UIV),UIV远端第1个椎体(UIV+1)、UIV远端第2个椎体的HU值。通过术前MRI测量L4下终板水平椎旁肌的相对功能横截面积(relative functional cross-sectional area,rFCSA)和功能肌肉-脂肪指数(functional muscle-fat index,FMFI)。使用ROC曲线确定UIV、UIV+1、UIV+2椎体HU值及椎旁肌rFCSA、FMFI的最佳截断值。使用二分类变量logistic回归分析确定PJK的独立危险因素。结果PJK组与非PJK组患者术前PT(17.60°±8.39°和24.12°±9.37°)、术后LL(35.61°±10.62°和42.22°±13.11°)、LSL(30.24°±10.10°和35.87°±11.12°)、SVA(37.82°±20.46°和21.37°±17.35°)的差异均有统计学意义(P<0.05);两组UIV椎体HU值(113.62±17.25和133.94±16.61)、UIV+1椎体HU值(123.14±16.03和138.27±13.69)、UIV+2椎体HU值(121.00±15.91和134.47±15.53)的差异均有统计学意义(P<0.05),最佳截断值分别为120.72、127.51、121.50;两组rFCSA(156.87±48.06和204.87±50.16)、FMFI(0.31±0.10和0.23±0.09)的差异均有统计学意义(P<0.05),最佳截断值分别为175.43和0.24。logistic回归分析显示术后Objective To investigate the risk factors for proximal junctional kyphosis(PJK)in adult spinal deformity patients with concomitant osteoporosis undergoing long-segment spinal fusion surgery.Methods A retrospective analysis was conducted on 76 adults spinal deformity patients with osteoporosis who underwent long-segment spinal fusion surgery at the Department of Orthopaedics,Beijing Chaoyang Hospital,between June 2013 and December 2019.The cohort included 19 males and 57 females,with a mean age of 66.26±6.10 years(range,54-78 years).Patients were categorized into two groups based on the occurrence of PJK within a 2-year postoperative follow-up:the PJK group(21 cases)and the non-PJK group(55 cases).Comparative analyses were performed on baseline characteristics,surgical details,preoperative and postoperative spinal-pelvic parameters,Hounsfield Units(HU)of the vertebral bodies,and paraspinal muscle morphology between the groups.Spinal-pelvic parameters included the main Cobb angle,lumbar lordosis(LL),lumbosacral lordosis(LSL),sagittal vertical axis(SVA),T1 pelvic angle(TPA),pelvic tilt(PT),sacral slope(SS),and pelvic incidence(PI).Preoperative CT was used to measure HU values at the upper instrumented vertebra(UIV),UIV+1,and UIV+2.Paraspinal muscle morphology,including the relative functional cross-sectional area(rFCSA)and functional muscle-fat index(FMFI)at the L4 lower endplate level,was assessed using preoperative MRI.Optimal cutoff values for HU and paraspinal muscle parameters were determined using receiver operating characteristic curve analysis.Multivariable logistic regression was employed to identify independent risk factors for PJK.Results Significant differences were observed between the PJK and non-PJK groups in preoperative PT(17.60°±8.39°vs.24.12°±9.37°),postoperative LL(35.61°±10.62°vs.42.22°±13.11°),LSL(30.24°±10.10°vs.35.87°±11.12°),and SVA(37.82°±20.46°vs.21.37°±17.35°).The differences were statistically significant(P<0.05).The HU values of UIV(113.62±17.25 vs.133.94±16.6

关 键 词：骨质疏松 脊柱融合术 脊柱后凸 危险因素 

分 类 号：R687.3[医药卫生—骨科学]