Department of Spine Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
Department of Spine Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Spine (Phila Pa 1976). 2017 Oct 15;42(20):E1197-E1203. doi: 10.1097/BRS.0000000000002109.
A retrospective study.
To determine the incidence and risk factors of proximal junctional kyphosis (PJK) in young children who underwent posterior instrumented spinal fusion.
PJK is a well-recognized postoperative complication in adults and adolescents. However, there is a paucity of valid data with regard to PJK in young children with congenital scoliosis (CS) who were treated with posterior correction surgery.
This study reviewed the charts and radiographs of a consecutive series of young children with CS who underwent posterior instrumentation and fusion (≥4 levels) from January 2008 to May 2013. The patients were followed up for more than 24 months. Radiographic measurements were made preoperatively and throughout the follow-up period. From sagittal images, the following values were obtained: proximal junctional angle, sagittal vertical axis, pelvic incidence, thoracic kyphosis, lumbar lordosis, and segmental kyphosis.
Totally 113 children were recruited in this study. The average age at surgery was 6.6 years, and the average follow-up period was 48.8 months. PJK occurred in 21 of the 113 patients and were mostly classified as ligamentous failure. In comparison with the non-PJK group, the PJK group showed greater preoperative Thoracic kyphosis (TK) (45.9° vs. 37.3°, P = 0.027), longer fusion levels (6.6 vs. 5.4, P < 0.01), and greater segmental kyphosis (SK) change (30.1° vs. 11.2°, P = 0.002). Both a change in SK greater than 30° and a preoperative TK greater than 40° were independent risk factors associated with PJK. In the PJK group, the average PJA increased by 12.4° at 3 months postoperatively and followed by slight improvement till the final follow-up.
This study demonstrates a high rate of PJK in young children after correction surgery for CS. PJK mainly occurs within 3 months postoperatively and its risk factors include preoperative hyperkyphosis, over-correction of kyphosis, and ligamentous failure.
回顾性研究。
确定接受后路器械脊柱融合术的儿童中近端交界性后凸(PJK)的发生率和危险因素。
PJK 是成人和青少年术后公认的并发症。然而,对于接受后路矫正手术治疗的先天性脊柱侧凸(CS)的幼儿,有关 PJK 的有效数据很少。
本研究回顾性分析了 2008 年 1 月至 2013 年 5 月连续接受后路器械固定融合(≥4 个节段)的儿童 CS 患者的病历和影像学资料。所有患者的随访时间均超过 24 个月。术前及随访期间均行影像学测量。从矢状面图像中获得以下值:近端交界角、矢状垂直轴、骨盆入射角、胸椎后凸、腰椎前凸和节段性后凸。
本研究共纳入 113 例患儿。手术时平均年龄为 6.6 岁,平均随访时间为 48.8 个月。113 例患儿中有 21 例发生 PJK,多为韧带失败。与非 PJK 组相比,PJK 组术前胸曲更大(45.9°比 37.3°,P=0.027),融合节段更长(6.6 比 5.4,P<0.01),节段性后凸变化更大(30.1°比 11.2°,P=0.002)。节段性后凸变化大于 30°和术前胸曲大于 40°均为 PJK 的独立危险因素。在 PJK 组中,术后 3 个月时平均 PJA 增加 12.4°,随后略有改善直至最终随访。
本研究显示,CS 患儿矫正术后 PJK 发生率较高。PJK 主要发生在术后 3 个月内,其危险因素包括术前后凸增加、过度矫正后凸和韧带失败。
4 级。