近端交界性后凸的危险因素分析

Risk Factors for Proximal Junctional Kyphosis

目的研究腰椎退行性疾病后路长节段固定融合术后近端交界性后凸(PJK)的危险因素。方法回顾性分析2012年10月至2014年7月因腰椎退行性疾病行后路长节段固定融合术患者118例,至少随访1.5年,在X线片上观察PJK的发生情况。结果共随访有完整资料的患者66例,平均随访3.2年,其中12例发生PJK(PJK组),其余为非PJK组。两组患者体质量指数、骨密度、末次随访Oswestry功能障碍指数评分有显著性差异(t>2.194,P<0.05)。两组患者上端固定椎位于胸腰段(T11~L1)的比率有显著性差异(χ2=4.63,P<0.05)。PJK组术前、术后及末次随访时PJK角显著大于非PJK组(t>3.862,P<0.001)。二元Logistic回归分析显示,骨质疏松(OR=5.328,95%CI:1.110~25.581)、上端固定椎位于胸腰段(OR=6.239,95%CI:1.157~33.648)、术前PJK角>10°(OR=5.789,95%CI:1.075~31.183)是发生PJK的危险因素。结论术前PJK角大于10°,上端固定椎位于胸腰段(T11~L1)及骨质疏松是腰椎长节段固定术后发生PJK的危险因素。

Objective To investigate the risk factors of proximal junctional kyphosis （PJK） after posterior long segmental lumbar fusion for degenerative lumbar disease. Methods From October, 2012 to July, 2014, 118 degenerative lumbar disease patients who accepted posterior long segmental fusion and followed up at least 1.5 years were reviewed. All the PJK were evaluated with X-ray. Results Sixty-six patients completed the follow-up （mean of 3.2 years）, in which 12 patients with PJK （PJK group）, and the others without （non-PJK group, n= 54）. There was significant difference in body mass index, bone density and the last Oswestry Disability Index scores （t〉2.194, P〈0.05） between both groups, as well as the rate of the upper instrumented vertebra （UIV） located in the thoracolumbar segment （TH-L） （;（2=4.63, P〈 0.05）. The PJK angle was more in PJK group than non-PJK group pre-surgery, post-surgery and finally （t〉3.862, P〈0.001）. Binary Logistic regression showed that osteoporosis （OR=5.328, 95% CI： 1.110-25.581）, UIV located in the thoracolumbar segment （T11-L1） （OR=6.239, 95% CI： 1.157-33.648） and the pre-surgery PJK angle 〉10° （OR=5.789, 95% CI： 1.075-31.183） were the independent risk factors of PJK. Conclusion Osteoporosis, UIV located in the thoracolumbar segment （T11-L1） and the pre-surgery PJK angle 〉 10° are risk factors of PJK after posterior long segmental lumbar fusion.