Kanezaki Shozo, Miyazaki Masashi, Ishihara Toshinobu, Notani Naoki, Tsumura Hiroshi
Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Oita, Japan.
Medicine (Baltimore). 2018 Jul;97(28):e11442. doi: 10.1097/MD.0000000000011442.
The aim of the present study is to identify factors correlated with kyphotic deformity after thoracolumbar spine injuries. We performed a retrospective case-control study with data from thoracolumbar spine fracture patients who were treated with posterior spinal fixation. Patients with a follow-up period shorter than 6 months and who experienced low-energy trauma were excluded. Intervertebral disc injuries (IDIs) were graded from 0 to 3 upon admission in accordance with Sander's classification of traumatic intervertebral disc lesions. Vertebral wedge angles (VWAs) and local kyphosis angles (LKAs) were also measured. Patients were allocated to kyphosis and control groups if they had LKA correction losses of ≥10° and <10°, respectively. Forty-eight patients followed over a median period of 25 months were included. The median correction loss at the site of the injured vertebral body was 2.0°. The median LKA correction loss was 9.0°. Twenty-three and 25 patients were allocated to the kyphosis and control groups, respectively. Univariate analysis revealed that the median age was significantly lower in the kyphosis (35 years) than control group (56 years). The level of injury and IDI severity also significantly differed between groups, with a significantly greater proportion of more severe IDI cases in the kyphosis than control group. Finally, significantly more patients in kyphosis group underwent fusion (kyphosis, 19 vs control, 13) and implant removals (kyphosis, 19 vs control, 10). Multiple regression analysis revealed that IDI severity according to Sander's classification (P = .005; odds ratio, 5.263; 95% confidence interval [CI], 1.637-16.927) and implant removal (P = .011; odds ratio, 7.980; 95% CI, 1.603-39.728) were significantly associated with kyphotic deformity. IDI severity at initial magnetic resonance imaging (MRI) evaluation and implant removal are associated with kyphotic deformity after posterior fixation of thoracolumbar spine injuries. Thus, initial MRI evaluation of IDIs could be used to predict of recurrent kyphosis.
本研究的目的是确定与胸腰椎脊柱损伤后后凸畸形相关的因素。我们对接受后路脊柱固定治疗的胸腰椎脊柱骨折患者的数据进行了一项回顾性病例对照研究。排除随访期短于6个月且经历低能量创伤的患者。入院时根据桑德氏创伤性椎间盘损伤分类将椎间盘损伤（IDI）从0到3级进行分级。还测量了椎体楔角（VWA）和局部后凸角（LKA）。如果患者的LKA矫正丢失≥10°和<10°，则分别将其分配到后凸畸形组和对照组。纳入了48例患者，中位随访期为25个月。受伤椎体部位的中位矫正丢失为2.0°。LKA的中位矫正丢失为9.0°。分别有23例和25例患者被分配到后凸畸形组和对照组。单因素分析显示，后凸畸形组的中位年龄（35岁）显著低于对照组（56岁）。两组之间的损伤水平和IDI严重程度也有显著差异，后凸畸形组中更严重IDI病例的比例显著高于对照组。最后，后凸畸形组中接受融合术（后凸畸形组19例 vs 对照组13例）和植入物取出术（后凸畸形组19例 vs 对照组10例）的患者明显更多。多元回归分析显示，根据桑德氏分类的IDI严重程度（P = 0.005；比值比，5.263；95%置信区间[CI]，1.637 - 16.927）和植入物取出（P = 0.011；比值比，7.980；95%CI，1.603 - 39.728）与后凸畸形显著相关。胸腰椎脊柱损伤后路固定后，初始磁共振成像（MRI）评估时的IDI严重程度和植入物取出与后凸畸形相关。因此，对IDI的初始MRI评估可用于预测复发性后凸畸形。
