脊柱术后近端交界性后凸畸形的研究进展

The recent development of proximal junctional kyphosis after spinal surgery

目的：总结脊柱术后近端交界性后凸（PJK）的最新研究进展。方法以 proximal junctional kyphosis、incidence、spine 和近端交界性后凸、发病率、脊柱为关键词，分别在 PubMed、万方数据库查阅2000年1月—2015年5月有关 PJK 畸形的文献，分别对 PJK 的生物力学影响因素、影像学参数、诊断角度、分型、临床因素等方面的最新研究进展进行归纳和总结。结果脊柱手术中近端横连的使用可降低 PJK 的发生。手术时年龄〉55岁、腰椎前凸角〉30°、术前胸椎侧弯角〉30°、术前胸椎后凸角〉30°、术前术后腰椎前凸角改变〉30°、T5~12胸椎后凸角〉40°、前后路联合和后路手术可能是 PJK 发生的独立危险因素。 PJK 诊断的角度问题及 PJK 翻修的手术指症尚无统一意见。结论PJK 的发生是多因素共同作用的结果，与脊柱的生物力学、影像学参数、临床因素具有一定的相关性。PJK 的危险因素目前尚无统一定论，还需进一步深入研究。

Objective To summarize and conclude recent development of Proximal junctional kyphosis （PJK）. Methods To search the references related to PJK using ＆quot; proximal junctional kyphosis＆quot; ,＆quot; incidence＆quot; , ＆quot; spine＆quot; and “近端交界性后凸”,“发生率”,“脊柱” as the key words in the PubMed and Wanfang database from January 2000 to May 2015. To summarize in aspect of biomechanical influence factors, the radiographic parameters, the diagnosis, type, the clinical factors of PJK. Results By analyzing and concluding, using cross-linkage at proximal area can decrease the incidence of PJK, however, older age at surgery 〉 50 years, lumbar lordosis angle 〉 30°, preoperatively thoracic scoliosis angle 〉 30°, thoracic kyphosis 〉 30°, change of lumbar lordosis angle between preoperatively and postoperatively 〉 30°, thoracic kyphosis angle of T5 - T12 thoracic kyphosis 〉 40°, combination of anterior and posterior surgery were probably risk factors of PJK. There was no consensus on the point of view of PJK diagnosis and surgical indication for revision of PJK. Conclusions PJK occurs as a result of interaction of multiple factors. It is certainly associated with the biomechanics of the spine, radiographic parameters, and clinical factors. But the risk factors of PJK are still unclear, and need to be explored by further study.