年龄调整对线目标有可能降低 PJK。
Age-Adjusted Alignment Goals Have the Potential to Reduce PJK.
机构信息
Spine Service, Hospital for Special Surgery, New York, NY.
Department of Orthopedic Surgery, University of Louisville Medical Center, Louisville, KY.
出版信息
Spine (Phila Pa 1976). 2017 Sep 1;42(17):1275-1282. doi: 10.1097/BRS.0000000000002146.
STUDY DESIGN
Retrospective cohort.
OBJECTIVE
To explore proximal junctional kyphosis (PJK) as a function of age-adjusted surgical correction goals.
SUMMARY OF BACKGROUND DATA
Recent adult spinal deformity (ASD) studies show that alignment targets are age-specific. Despite recognizing age and malalignment as PJK risk factors, no study has assessed the age-specific effects of alignment on PJK.
METHODS
ASD patients with fusions to the pelvis were included and stratified into three groups: young adults (YA <40 years old), middle aged (MA: 40-65 years old), and the elderly (ED >65 years old). Analysis of variance compared the groups with respect to 1-year postoperative alignments and 1-year offsets from age-specific alignment targets.
RESULTS
A total of 679 patients were enrolled (mean age = 61 years old, 77% female, body mass index = 28.1). At 1 year postoperatively, there was a significant decrease in pelvic tilt (PT; 29-23°), spinopelvic mismatch (pelvic incidence [PI]-lumbar lordosis [LL]) (28-5°), and sagittal vertical axis (SVA; 110-37 mm); overall incidence of PJK was 45.1%. Stratification by age (YA, n = 28; MA, n = 389; ED, n = 262) revealed an increase in PJK incidence with age: YA = 17.9%, MA = 43.8%, and ED = 50.2% (P < 0.001). PJK patients had smaller postoperative PI-LL mismatches (ED 0.8° vs. 9.8°, MA 3.1° vs. 7.3°) than non-PJK patients, without any significant differences in PT or SVA. Analysis of the postoperative offsets from age-specific norms revealed that PJK patients in the two older subgroups and in the study cohort as a whole were overcorrected as compared to non-PJK patients (PI-LL offset-all: -5.2° vs. 2.8°, MA: -1° vs. +4°, ED: -11° vs. -2°; SVA offset-all: -10 mm vs. 7 mm, MA: -3 mm vs. 10 mm, ED: -18 mm vs. -6 mm). The correlation coefficients between PJK angles and the offsets from age-adjusted objective were small (0.320 for PI-LL, 0.114 for PT, and 0.136 for SVA).
CONCLUSION
Overall, this study suggests that PJK patients were overcorrected when compared to age-adjusted alignment goals. Certainly, elderly patients are subject to independent risk factors for PJK, making the prevention of PJK complex. However, individualized optimization of surgical alignment can improve outcomes. This emphasizes the need for surgeons to incorporate age-specific alignment targets into the standard preoperative planning process.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
探讨近端交界性后凸（PJK）与年龄调整后的手术矫正目标的关系。
背景资料概要
最近的成人脊柱畸形（ASD）研究表明，脊柱的对线目标是年龄特异性的。尽管已经认识到年龄和对线不良是 PJK 的危险因素，但没有研究评估对线对线不良的年龄特异性影响。
方法
纳入接受骨盆融合的 ASD 患者，并将其分为三组：年轻成人（YA <40 岁）、中年（MA：40-65 岁）和老年（ED >65 岁）。方差分析比较了三组患者术后 1 年的对线情况以及与年龄特异性对线目标的 1 年偏移情况。
结果
共纳入 679 例患者（平均年龄 61 岁，女性占 77%，体重指数 28.1）。术后 1 年，骨盆倾斜度（PT；29-23°）、骨盆入射角（PI）-腰椎前凸（LL）不匹配（28-5°）和矢状垂直轴（SVA；110-37 mm）显著降低；总体 PJK 发生率为 45.1%。按年龄分层（YA，n=28；MA，n=389；ED，n=262）显示，PJK 发生率随年龄增加而增加：YA=17.9%，MA=43.8%，ED=50.2%（P<0.001）。PJK 患者术后 PI-LL 不匹配较小（ED 0.8° vs. 9.8°，MA 3.1° vs. 7.3°），但与非 PJK 患者相比，PT 或 SVA 无显著差异。对年龄特异性标准术后偏移的分析显示，与非 PJK 患者相比，两个年龄较大的亚组和整个研究组的 PJK 患者均出现过度矫正（PI-LL 偏移总和：-5.2° vs. 2.8°，MA：-1° vs. +4°，ED：-11° vs. -2°；SVA 偏移总和：-10 mm vs. 7 mm，MA：-3 mm vs. 10 mm，ED：-18 mm vs. -6 mm）。PJK 角度与年龄调整后的客观指标之间的相关系数较小（PI-LL 为 0.320，PT 为 0.114，SVA 为 0.136）。
结论
总体而言，本研究表明，与年龄调整后的对线目标相比，PJK 患者存在过度矫正。当然，老年患者存在 PJK 的独立危险因素，使 PJK 的预防变得复杂。然而，手术对线的个体化优化可以改善结果。这强调了外科医生将年龄特异性对线目标纳入标准术前规划过程的必要性。
证据水平
3 级。
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