Zhao Jian, Yang Mingyuan, Yang Yiling, Chen Ziqiang, Li Ming
Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Department of Orthopedics, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
J Orthop Sci. 2018 Sep;23(5):744-749. doi: 10.1016/j.jos.2018.05.010. Epub 2018 Jun 28.
To investigate the risk factors of proximal junctional kyphosis (PJK) in Lenke 5 AIS patients after all-pedicle instrumentation and correction, and to compare the difference of radiographic and clinical outcome between PJK and Non-PJK populations.
Medical records of Lenke 5 AIS patients were reviewed from January 2008 to January 2013, included posteroanterior and lateral full spine X-ray films preoperatively, postoperatively (4-7 days after surgery), and at final follow-up. Demographic data and radiologic parameters were evaluated. Based on the proximal junctional angle (PJA) at final follow-up, those patients were divided into 2 groups: PJK group (n = 35, PJA≧10°), and Non-PJK group (n = 52, PJA<10°). Comparisons analyses between PJK and Non-PJK groups were carried out. Binary logistic Regression analysis was performed to detect the risk factors of PJK at follow-up.
The current study recruited 87 Lenke 5 AIS patients with average follow-up of 4.67 ± 1.17 years. Significant differences between PJK and Non-PJK groups were observed as follows: UIV(P = 0.010), the disruption of junctional ligaments (P < 0.001); preoperative variables [MTC (P = 0.001), TK(P < 0.001), LL (P = 0.017), SVA (P = 0.036), and PJA (P = 0.014)], postoperative variables [TLK(P = 0.004), and PJA (P < 0.001)], and follow-up [SVA (P = 0.014), C-SVA (P < 0.001), and PJA (P0.001). Binary logistic regression showed that the disruption of junctional ligaments, postoperative PJA and UIV (upper instrumented vertebra) at proximal or lower thoracic levels were the main risk factors of PJK [Odds Ratio (OR) = 5.114, 2.345, and 6.212, respectively]. However, the SRS-22 scores did not change significantly in PJK and Non-PJK groups.
Greater postoperative PJA, disruption of junctional ligaments, UIV at lower thoracic levels were the main risk factors for PJK in Lenke 5 AIS patients. Recommedation: Preserve junctional ligaments in those individuals with UIV located in the lower thoracic region.
探讨Lenke 5型青少年特发性脊柱侧凸（AIS）患者在全椎弓根器械固定及矫正术后近端交界性后凸（PJK）的危险因素，并比较PJK组与非PJK组在影像学和临床结果上的差异。
回顾2008年1月至2013年1月Lenke 5型AIS患者的病历，包括术前、术后（术后4 - 7天）及末次随访时的全脊柱正侧位X线片。评估人口统计学数据和放射学参数。根据末次随访时的近端交界角（PJA），将患者分为两组：PJK组（n = 35，PJA≥10°）和非PJK组（n = 52，PJA<10°）。对PJK组和非PJK组进行比较分析。采用二元逻辑回归分析来检测随访时PJK的危险因素。
本研究纳入87例Lenke 5型AIS患者，平均随访4.67±1.17年。PJK组和非PJK组之间观察到显著差异如下：上终椎（UIV，P = 0.010）、交界韧带断裂（P < 0.001）；术前变量[主胸弯（MTC，P = 0.001）、胸弯（TK，P < 0.001）、腰椎前凸（LL，P = 0.017）、矢状面垂直轴（SVA，P = 0.036）和PJA（P = 0.014）]，术后变量[胸腰段后凸（TLK，P = 0.004）和PJA（P < 0.001）]，以及随访时[SVA（P = 0.014）、颈椎矢状面垂直轴（C - SVA，P < 0.001）和PJA（P < 0.001）]。二元逻辑回归显示，交界韧带断裂、术后PJA以及近端或下胸段的上终椎（UIV）是PJK的主要危险因素[比值比（OR）分别为5.114、2.345和6.212]。然而，PJK组和非PJK组的SRS - 22评分没有显著变化。
术后较大的PJA、交界韧带断裂、下胸段的UIV是Lenke 5型AIS患者发生PJK的主要危险因素。建议：对于UIV位于下胸段的个体，保留交界韧带。
