Lee Byoung Hun, Hyun Seung-Jae, Han Sanghyun, Jeon Se-Il, Kim Ki-Jeong, Jahng Tae-Ahn, Kim Hyun-Jib
Department of Neurosurgery, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea.
Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
J Korean Neurosurg Soc. 2018 Nov;61(6):723-730. doi: 10.3340/jkns.2018.0125. Epub 2018 Oct 30.
The aim of the present study was to identify whether the deformity angular ratio (DAR) influences the occurrence of complications after posterior vertebral column resection (PVCR) and to establish the DAR cut-off value.
Thirty-six consecutive patients undergoing PVCR from December 2010 to October 2016 were reviewed. The relationships between the total, sagittal, and coronal DAR and complications were assessed using receiver operator characteristics curves. The patients were divided into two groups according to a reference value based on the cut-off value of DAR. Demographic, surgical, radiological, and clinical outcomes were compared between the groups.
There were no significant differences in the patient demographic and surgical data between the groups. The cut-off values for the total DAR (T-DAR) and the sagittal DAR (S-DAR) were 20.2 and 16.4, respectively (p=0.018 and 0.010). Both values were significantly associated with complications (p=0.016 and 0.005). In the higher T-DAR group, total complications (12 vs. 21, p=0.042) and late-onset complications (3 vs. 9, p=0.036) were significantly correlated with the T-DAR. The number of patients experiencing complications (9 vs. 11, p=0.029) and the total number of complications (13 vs. 20, p=0.015) were significantly correlated with the S-DAR. Worsening intraoperative neurophysiologic monitoring was more frequent in the higher T-DAR group (2 vs. 4) than in the higher S-DAR group (3 vs. 3). There was no difference in neurological deterioration between the groups after surgery.
Both the T-DAR and the S-DAR are risk factors for complications after PVCR. Those who had a T-DAR >20.2 or S-DAR >16.4 experienced a higher rate of complications after PVCR.
本研究旨在确定畸形角比（DAR）是否会影响后路脊柱切除术（PVCR）后并发症的发生，并确定DAR的临界值。
回顾了2010年12月至2016年10月期间连续接受PVCR的36例患者。使用受试者操作特征曲线评估总DAR、矢状面DAR和冠状面DAR与并发症之间的关系。根据基于DAR临界值的参考值将患者分为两组。比较两组之间的人口统计学、手术、放射学和临床结果。
两组患者的人口统计学和手术数据无显著差异。总DAR（T-DAR）和矢状面DAR（S-DAR）的临界值分别为20.2和16.4（p=0.018和0.010）。这两个值均与并发症显著相关（p=0.016和0.005）。在较高T-DAR组中，总并发症（12比21，p=0.042）和迟发性并发症（3比9，p=0.036）与T-DAR显著相关。发生并发症的患者数量（9比11，p=0.029）和并发症总数（13比20，p=0.015）与S-DAR显著相关。较高T-DAR组术中神经生理监测恶化的情况（2比4）比高S-DAR组（3比3）更频繁。术后两组之间神经功能恶化无差异。
T-DAR和S-DAR均为PVCR后并发症的危险因素。T-DAR>20.2或S-DAR>16.4的患者在PVCR后并发症发生率更高。
