成人脊柱畸形手术后机械并发症的预测因素的识别：一项多机构回顾性研究。
Identification of Predictive Factors for Mechanical Complications After Adult Spinal Deformity Surgery: A Multi-Institutional Retrospective Study.
机构信息
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Bunkyo City, Tokyo, Japan.
Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan.
出版信息
Spine (Phila Pa 1976). 2020 Sep 1;45(17):1185-1192. doi: 10.1097/BRS.0000000000003500.
STUDY DESIGN
A retrospective multicenter observational study.
OBJECTIVE
To investigate correction surgeries that were performed in relatively aged patients in terms of mechanical complications (MCs) and their predictive factors.
SUMMARY OF BACKGROUND DATA
The risk factors associated with MCs have not yet been well examined, especially in aged populations.
METHODS
We retrospectively reviewed 230 surgically treated ASD patients with an average age of 72.2 years. Twenty-eight patients with ASD caused by vertebral fractures were excluded. The minimum follow-up was 2 years. Postoperative MCs were defined as proximal junction kyphosis, distal junction kyphosis, pseudoarthrosis, rod breakage, and vertebral fractures. We divided all the ASD patients into two groups: patients with MC (the MC (+) group) and patients without MC (the MC (-) group). Radiographic parameters were evaluated before and immediately after surgery. The SRS-Schwab ASD classification and global alignment and proportion (GAP) score were also evaluated.
RESULTS
Of the 202 patients, 91 (45.0%) had MCs. The age at surgery was significantly higher in the MC (+) group than in the MC (-) group. Regarding radiographic parameters, postoperative global tilt (GT), pre- and postoperative thoracolumbar kyphosis (TLK), and postoperative thoracic kyphosis were significantly higher in the MC (+) group than in the MC (-) group. Other parameters, such as the proposed ideal alignment target of PI-LL<10, did not significantly affect MC rates. The GAP score was high in both groups and not significantly related to a higher rate of MC. Forward stepwise logistic regression indicated that the age at surgery, postoperative GT, and preoperative TLK were significant risk factors for MCs.
CONCLUSION
Older age, higher postoperative GT, and higher pre and postoperative TLK can be risk factors for MCs. The GAP score was high in both groups and not significantly related to a higher rate of MC.
LEVEL OF EVIDENCE
研究设计
回顾性多中心观察研究。
目的
探讨在相对高龄患者中发生机械并发症（MCs）的矫正手术及其预测因素。
背景资料总结
与 MCs 相关的危险因素尚未得到充分研究，尤其是在老年人群中。
方法
我们回顾性分析了 230 例平均年龄为 72.2 岁的接受 ASD 手术治疗的患者。排除了 28 例由椎体骨折引起的 ASD 患者。随访时间至少为 2 年。术后 MCs 定义为近端交界性后凸、远端交界性后凸、假关节、棒断裂和椎体骨折。我们将所有 ASD 患者分为两组：有 MC 的患者（MC(+) 组）和无 MC 的患者（MC(-) 组）。评估了术前和术后即刻的影像学参数。还评估了 SRS-Schwab ASD 分类和整体平衡与比例（GAP）评分。
结果
在 202 例患者中，91 例（45.0%）发生 MCs。MC(+) 组的手术年龄明显高于 MC(-) 组。在影像学参数方面，MC(+) 组术后整体倾斜度（GT）、术前和术后胸腰椎后凸（TLK）以及术后胸椎后凸明显高于 MC(-) 组。其他参数，如 PI-LL<10 的理想对线目标，对 MC 发生率没有显著影响。两组的 GAP 评分均较高，与 MC 发生率较高无显著相关性。逐步向前逻辑回归表明，手术年龄、术后 GT 和术前 TLK 是 MCs 的显著危险因素。
结论
年龄较大、术后 GT 较高以及术前和术后 TLK 较高可能是 MCs 的危险因素。两组的 GAP 评分均较高，与 MC 发生率较高无显著相关性。
证据水平
4 级。
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