影响成人脊柱畸形术后胃食管反流病改善的关键影像学参数：至少 2 年随访。

Key Radiographic Parameters That Influence the Improvement of Postoperative Gastroesophageal Reflux Disease in Patients Treated Surgically for Adult Spinal Deformity With a Minimum 2-Year Follow-up.

机构信息

Department of Orthopaedic Surgery, University of Yamanashi, Japan.

Department of Orthopaedic Surgery, School of Medicine, Shinshu University, Japan.

出版信息

Spine (Phila Pa 1976). 2020 Aug 1;45(15):E943-E949. doi: 10.1097/BRS.0000000000003459.

DOI:10.1097/BRS.0000000000003459

PMID:32675609

Abstract

STUDY DESIGN

Retrospective observational study.

OBJECTIVE

The study objectives were to: (1) determine radiographically which spinal malalignment parameters predominantly influence the risk of gastroesophageal reflux disease (GERD); (2) evaluate the outcome of GERD 2 years after surgery for adult spinal deformity (ASD); and (3) clarify key factors that influence the improvement of postoperative GERD in ASD.

SUMMARY OF BACKGROUND DATA

Spinal deformity is reported to be involved in the pathology of GERD. Our previous study found that approximately 50% of patients treated surgically for ASD had GERD symptoms. However, the postoperative progress of GERD and the key factors that influence the improvement of postoperative GERD are largely unknown.

METHODS

Ninety-two patients with ASD treated with thoracolumbar corrective surgery and followed up for a minimum of 2 years were enrolled. All patients were asked to complete the Frequency Scale for Symptoms of GERD (FSSG) questionnaire preoperatively and at 1 and 2 years after surgery. GERD was diagnosed by FSSG score more than 8 points. Before, and at 1 and 2 years after surgery, full-length lateral radiographs were taken and radiographic parameters were obtained.

RESULTS

Patients were classified into two groups based on GERD symptoms, with 47 (51.1%) in the GERD+ group. Among parameters assessed, only thoracolumbar kyphosis (TLK) was significantly greater in the GERD+ group than in the GERD- group. The FSSG score improved significantly 1 year after surgery, but no significant difference was found between groups at 2 years. A significant correction loss of TLK was observed 2 years after surgery. There was a significant highly positive correlation between the FSSG score and TLK at 2 years after surgery.

CONCLUSION

GERD improved with correction of the spinal deformity but significant correction loss of the TLK even within the fusion presumably due to subsidence or proximal junctional kyphosis resulted in a cessation of that improvement over time.

LEVEL OF EVIDENCE

摘要

研究设计

回顾性观察研究。

目的

本研究的目的是：（1）确定哪些脊柱畸形参数主要影响胃食管反流病（GERD）的风险；（2）评估成人脊柱畸形（ASD）手术后 2 年 GERD 的结果；（3）阐明影响 ASD 术后 GERD 改善的关键因素。

背景资料概要

脊柱畸形与 GERD 的发病机制有关。我们之前的研究发现，大约 50%接受 ASD 手术治疗的患者有 GERD 症状。然而，GERD 的术后进展以及影响术后 GERD 改善的关键因素在很大程度上尚不清楚。

方法

纳入 92 例接受胸腰椎矫正手术并随访至少 2 年的 ASD 患者。所有患者均在术前、术后 1 年和 2 年完成胃食管反流病症状频率量表（FSSG）问卷。FSSG 评分大于 8 分诊断为 GERD。术前及术后 1 年和 2 年均拍摄全长侧位片，获取影像学参数。

结果

根据 GERD 症状将患者分为两组，其中 GERD+组 47 例（51.1%）。在评估的参数中，仅胸腰椎后凸角（TLK）在 GERD+组显著大于 GERD-组。术后 1 年 FSSG 评分显著改善，但两组间无显著差异。术后 2 年 TLK 矫正丢失明显。术后 2 年 FSSG 评分与 TLK 呈显著正相关。