骨质疏松性椎体塌陷伴延迟神经功能缺损融合手术后近端交界性骨折的危险因素：一项对403例患者的回顾性队列研究。
Risk Factors for Proximal Junctional Fracture Following Fusion Surgery for Osteoporotic Vertebral Collapse with Delayed Neurological Deficits: A Retrospective Cohort Study of 403 Patients.
作者信息
Tamai Koji, Terai Hidetomi, Suzuki Akinobu, Nakamura Hiroaki, Watanabe Kei, Katsumi Keiichi, Ohashi Masayuki, Shibuya Yohei, Izumi Tomohiro, Hirano Toru, Kaito Takashi, Yamashita Tomoya, Fujiwara Hiroyasu, Nagamoto Yukitaka, Matsuoka Yuji, Suzuki Hidekazu, Nishimura Hirosuke, Tagami Atsushi, Yamada Syuta, Adachi Shinji, Yoshii Toshitaka, Ushio Shuta, Harimaya Katsumi, Kawaguchi Kenichi, Yokoyama Nobuhiko, Oishi Hidekazu, Doi Toshiro, Kimura Atsushi, Inoue Hirokazu, Inoue Gen, Miyagi Masayuki, Saito Wataru, Nakano Atsushi, Sakai Daisuke, Nukaga Tadashi, Ikegami Shota, Shimizu Masayuki, Futatsugi Toshimasa, Ohtori Seiji, Furuya Takeo, Orita Sumihisa, Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Kiyasu Katsuhito, Murakami Hideki, Yoshioka Katsuhito, Seki Shoji, Hongo Michio, Kakutani Kenichiro, Yurube Takashi, Aoki Yasuchika, Oshima Masashi, Takahata Masahiko, Iwata Akira, Endo Hirooki, Abe Tetsuya, Tsukanishi Toshinori, Nakanishi Kazuyoshi, Watanabe Kota, Hikata Tomohiro, Suzuki Satoshi, Isogai Norihiro, Okada Eijiro, Funao Haruki, Ueda Seiji, Shiono Yuta, Nojiri Kenya, Hosogane Naobumi, Ishii Ken
机构信息
Department of Orthopaedic Surgery, Osaka City University, Osaka City, Japan.
Department of Orthopaedic Surgery, Niigata University, Niigata City, Japan.
出版信息
Spine Surg Relat Res. 2018 Oct 19;3(2):171-177. doi: 10.22603/ssrr.2018-0068. eCollection 2019 Apr 27.
INTRODUCTION
Approximately 3% of osteoporotic vertebral fractures develop osteoporotic vertebral collapse (OVC) with neurological deficits, and such patients are recommended to be treated surgically. However, a proximal junctional fracture (PJFr) following surgery for OVC can be a serious concern. Therefore, the aim of this study is to identify the incidence and risk factors of PJFr following fusion surgery for OVC.
METHODS
This study retrospectively analyzed registry data collected from facilities belonging to the Japan Association of Spine Surgeons with Ambition (JASA) in 2016. We retrospectively analyzed 403 patients who suffered neurological deficits due to OVC below T10 and underwent corrective surgery; only those followed up for ≥2 years were included. Potential risk factors related to the PJFr and their cut-off values were calculated using multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis.
RESULTS
Sixty-three patients (15.6%) suffered PJFr during the follow-up (mean 45.7 months). In multivariate analysis, the grade of osteoporosis (grade 2, 3: adjusted odds ratio (aOR) 2.92; p=0.001) and lower instrumented vertebra (LIV) level (sacrum: aOR 6.75; p=0.003) were independent factors. ROC analysis demonstrated that lumbar bone mineral density (BMD) was a predictive factor (area under curve: 0.72, p=0.035) with optimal cut-off value of 0.61 g/cm (sensitivity, 76.5%; specificity, 58.3%), but that of the hip was not (p=0.228).
CONCLUSIONS
PJFr was found in 16% cases within 4 years after surgery; independent risk factors were severe osteoporosis and extended fusion to the sacrum. The lumbar BMD with cut-off value 0.61 g/cm may potentially predict PJFr. Our findings can help surgeons select perioperative adjuvant therapy, as well as a surgical strategy to prevent PJFr following surgery.
引言
约3%的骨质疏松性椎体骨折会发展为伴有神经功能缺损的骨质疏松性椎体塌陷（OVC），此类患者建议接受手术治疗。然而，OVC手术后发生的近端交界性骨折（PJFr）可能是一个严重问题。因此，本研究旨在确定OVC融合手术后PJFr的发生率及危险因素。
方法
本研究回顾性分析了2016年从日本脊柱外科医师雄心协会（JASA）所属机构收集的登记数据。我们回顾性分析了403例因T10以下OVC导致神经功能缺损并接受矫正手术的患者；仅纳入随访时间≥2年的患者。使用多因素逻辑回归分析和受试者工作特征（ROC）分析计算与PJFr相关的潜在危险因素及其截断值。
结果
63例患者（15.6%）在随访期间（平均45.7个月）发生PJFr。多因素分析显示，骨质疏松分级（2级、3级：调整优势比（aOR）2.92；p = 0.001）和下固定椎（LIV）水平（骶骨：aOR 6.75；p = 0.003）是独立因素。ROC分析表明，腰椎骨密度（BMD）是一个预测因素（曲线下面积：0.72，p = 0.035），最佳截断值为0.61 g/cm²（敏感性76.5%；特异性58.3%），但髋部骨密度不是（p = 0.228）。
结论
术后4年内16%的病例发生了PJFr；独立危险因素为严重骨质疏松和融合至骶骨。截断值为0.61 g/cm²的腰椎BMD可能预测PJFr。我们的研究结果有助于外科医生选择围手术期辅助治疗以及预防术后PJFr的手术策略。
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