胸腰段脊柱侧凸行后路选择性融合术后发生近端交界性后凸的临床研究

The clinical study of proximal junctional kyphosis after selected spinal fusion with posterior instrumen-tation in thoracolumbar scoliosis

目的研究胸腰段脊柱侧凸行后路选择性矫形融合术后发生近端交界性后凸畸形的状况,并探讨其发生的危险因素。方法回顾性分析2000～2005年接受后路选择性融合手术的42例胸腰段脊柱侧凸患者,观察其矢状面上近端交界区后凸角度的变化情况;观察时间点至少包括术前、术后2周、术后3个月、术后1.5年及末次随访。结果所有42例患者平均随访2.5年,其中13例(31%)发生近端交界性后凸畸形,但是没有患者接受翻修手术。发生后凸畸形的13例患者术前平均腰椎前凸角度为48.7°,术中前凸平均减少14.3°。42例患者中7例术前近端交界区的后凸角度大于10°,术后均发生了近端交界区后凸畸形。结论对于胸腰段脊柱侧凸患者的手术入路选择上,后路节段性融合术适用于术前局部交界区后凸角度小于10°的患者,同时术中应尽量避免对腰椎生理前凸的破坏。

Objective To study the condition of proximal junctional kyphosis （PJK） after selected spinal fusion with posterior approach in thoracolumbar Scoliosis, and analyze the risk factors. Methods A total of 42 patients with idiopathic thoracolumbar curve underwent selected spinal fusion with posterior instrumentation in our hospital between 2000 and 2005. The changes of sagittal Cobb＇s angle at the proximal junction were recorded before preoperation, 2 weeks, 3 months, and 1.5 year after operation and at the final follow-up. Results All patients were followed up for an average of 2.5 years. Thirteen patients （31%） developed PJK, but none underwent revision. The average pre-operative and post-operative lumbar lordosis of them were 48.7 ° and 34.4°, respectively. Seven patients with a pre-operative larger than 10° kyphosis developed proximal junctional kyphosis after surgery. Conclusion Segmental fuison with posterior instrumentation is suitable for patients whose pre-operative local kyphotic angle is less than 10°. The normal lumbar lordosis should be maintained at the process of instrumentation.