Oe Shin, Togawa Daisuke, Hasegawa Tomohiko, Yamato Yu, Yoshida Go, Kobayashi Sho, Yasuda Tatsuya, Banno Tomohiro, Arima Hideyuki, Mihara Yuki, Ushirozako Hiroki, Matsuyama Yukihiro
Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka, Japan 431-3192.
Department of Orthopedic Surgery and Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu City, Shizuoka, Japan 431-3192.
Spine Deform. 2019 Sep;7(5):759-770. doi: 10.1016/j.jspd.2018.12.007.
A retrospective study of surgical outcomes.
This study aimed to investigate the preoperative risk factors for proximal junctional kyphosis (PJK) in adult spinal deformity (ASD) surgery.
The cause of PJK is still unclear, although some risk factors have been reported in ASD surgery.
A total of 185 patients who were followed up for more than two years and underwent ASD surgery were recruited. PJK was defined as a proximal junctional angle ≥20° or reoperation due to PJK within two years after surgery. These patients were divided into PJK and non-PJK groups. Whole-spine standing radiography was performed before and immediately, one year, and two years after the surgery.
The PJK and non-PJK groups comprised 58 and 127 cases, respectively. The incidence of PJK demonstrated significant differences according to preoperative thoracic kyphosis (TK): 37% (TK ≤19°), 33% (TK 20°-29°), 9% (TK 30°-39°), 32% (TK 40°-49°), and 41% (TK ≥50°) (p < .05). Logistic regression analysis suggested that the amount of change in TK before and just after the surgery (ΔTK) was a significant risk factor for PJK (p < .001; odds ratio 1.062, 95% confidence interval 1.029-1.097).
ΔTK was less in the TK group of 30°-39° because the TK of patients who underwent ASD surgery converged to 34.5° just after surgery. Consequently, a lower or higher TK was likely to result in a large ΔTK just after surgery. Therefore, patients who had an optimal TK (30°-39°) had a lower risk of PJK.
Level IV.
一项关于手术结果的回顾性研究。
本研究旨在调查成人脊柱畸形（ASD）手术中近端交界性后凸（PJK）的术前危险因素。
尽管在ASD手术中已报道了一些危险因素，但PJK的病因仍不清楚。
共纳入185例接受ASD手术且随访超过两年的患者。PJK定义为近端交界角≥20°或术后两年内因PJK再次手术。这些患者被分为PJK组和非PJK组。在手术前、术后即刻、术后一年和术后两年进行全脊柱站立位X线摄影。
PJK组和非PJK组分别有58例和127例。根据术前胸椎后凸（TK），PJK的发生率显示出显著差异：37%（TK≤19°），33%（TK 20°-29°），9%（TK 30°-39°），32%（TK 40°-49°）和41%（TK≥50°）（p<.05）。逻辑回归分析表明，手术前后TK的变化量（ΔTK）是PJK的一个显著危险因素（p<.001；比值比1.062，95%置信区间1.029-1.097）。
30°-39°的TK组中ΔTK较小，因为接受ASD手术的患者术后TK立即收敛至34.5°。因此，较低或较高的TK可能导致术后即刻出现较大的ΔTK。所以，具有最佳TK（30°-39°）的患者发生PJK的风险较低。
四级。
