Pan Aixing, Hai Yong, Yang Jincai, Zhang Yangpu, Zhang Yaoshen
Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Clin Spine Surg. 2018 Aug;31(7):E337-E341. doi: 10.1097/BSD.0000000000000661.
A retrospective case series.
We sought to evaluate the prevalence and risk factors of proximal junctional kyphosis (PJK) after growing-rod surgery in patients with early onset scoliosis (EOS).
Growing-rod surgery is the primary treatment in patients with progressive EOS when conservative treatment fails. PJK is one of the most commonly reported postoperative complications.
We retrospectively evaluated 50 patients (24 boys and 26 girls) diagnosed with EOS who underwent growing-rod surgery. Preoperative and follow-up demographic data, surgical strategies, and radiographic parameters were recorded and analyzed to identify PJK risk factors.
The mean age of patients at the time of the initial surgery was 8.6±2.5 years. Mean follow-up was 33.5±10.8 months, and mean number of lengthening surgeries were 2.14±1.52. Twenty-eight of the surgical procedures were single growing-rod surgeries, of which 22 were dual growing-rod surgeries. The upper instrumented vertebrae (UIV) ranged from C6-T6, and the lower instrumented vertebrae ranged from L1-S1. Ultimately, PJK developed in 14 (28%) of 50 patients. Taller patients, UIV distal to T2, and greater postoperative upper thoracic scoliosis (UTS) were suspected potential risk factors of PJK during the univariate analysis (P<0.1). Multifactorial regression analysis confirmed that UIV distal to T2 (hazard ratio=5.474; P=0.044) and postoperative UTS >50 degrees (hazard ratio=1.049; P=0.046) were the independent risk factors of PJK during growing-rod treatment in patients with EOS.
The prevalence of PJK was 28% during growing-rod treatment in EOS. The independent risk factors for PJK were UIV distal to T2 and postoperative UTS >50 degrees. It is important for spine surgeons to recognize these risk factors when planning surgeries, and counseling patients and families about this possible complication.
Level III.
一项回顾性病例系列研究。
我们试图评估早发性脊柱侧弯（EOS）患者在生长棒手术术后近端交界性后凸（PJK）的发生率及危险因素。
当保守治疗无效时，生长棒手术是进行性EOS患者的主要治疗方法。PJK是最常报道的术后并发症之一。
我们回顾性评估了50例诊断为EOS并接受生长棒手术的患者（24例男性和26例女性）。记录并分析术前及随访的人口统计学数据、手术策略和影像学参数，以确定PJK的危险因素。
初次手术时患者的平均年龄为8.6±2.5岁。平均随访时间为33.5±10.8个月，平均延长手术次数为2.14±1.52次。28例手术为单根生长棒手术，其中22例为双根生长棒手术。上固定椎（UIV）范围为C6 - T6，下固定椎范围为L1 - S1。最终，50例患者中有14例（28%）发生了PJK。在单因素分析中，较高的患者、UIV位于T2远端以及术后上胸椎侧弯（UTS）较大被怀疑是PJK的潜在危险因素（P<0.1）。多因素回归分析证实，UIV位于T2远端（风险比=5.474；P=0.044）和术后UTS>50度（风险比=1.049；P=0.046）是EOS患者生长棒治疗期间PJK的独立危险因素。
EOS患者生长棒治疗期间PJK的发生率为28%。PJK的独立危险因素是UIV位于T2远端和术后UTS>50度。脊柱外科医生在规划手术时认识到这些危险因素，并就这种可能的并发症向患者及其家属提供咨询非常重要。
三级。
