Spine Center and Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 166 Gumiro, Bundang-gu, Sungnam, 463-707, Republic of Korea.
Department of Orthopedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, Republic of Korea.
Eur Spine J. 2021 May;30(5):1215-1225. doi: 10.1007/s00586-021-06830-3. Epub 2021 Apr 2.
This study aimed to examine which motion analysis parameters regarding the dynamic aspects and/or balance affect the development acute proximal junctional kyphosis (PJK) following adult spinal deformity (ASD) surgery.
A total of 90 consecutive patients were recruited prospectively, who underwent a corrective surgery for ASD with sagittal imbalance. According to the development of acute PJK within 6 months after surgery, the patients were divided into the PJK+ and PJK- groups. Before surgery, three-dimensional gait analyses were performed using a motion analysis system. The preoperative continuous and categorical variables were compared between the PJK+ and PJK- groups using independent t tests and chi-square tests, respectively. Finally, a multivariate logistic regression model was used to identify the risk factors and calculate the odds ratio (OR) for acute PJK.
A total of 20 and 70 patients were classified into the PJK+ and PJK- groups, respectively. There were no differences in the spinopelvic radiologic parameters pre- and postoperatively between the PJK+ and PJK- groups. The PJK+ group showed a significantly higher mean anterior pelvic tilt (Ant-PT) angle in preoperative motion analysis than the PJK- group (P = 0.001 for both sides). Multivariate analysis identified the mean Ant-PT angle (P = 0.047; OR 1.127; 95% CI 1.002-1.267) as a significant risk factor for acute PJK.
Preoperative Ant-PT angle during walking was associated with a higher OR in acute PJK after surgery.
本研究旨在探讨与动态方面和/或平衡有关的运动分析参数哪些会影响成人脊柱畸形（ASD）术后近端交界性后凸（PJK）的急性发展。
共前瞻性招募了 90 例连续接受 ASD 伴矢状面失平衡矫正手术的患者。根据术后 6 个月内是否发生急性 PJK，将患者分为 PJK+组和 PJK-组。术前使用运动分析系统进行三维步态分析。使用独立 t 检验和卡方检验分别比较 PJK+组和 PJK-组的术前连续和分类变量。最后，采用多变量逻辑回归模型确定急性 PJK 的危险因素，并计算优势比（OR）。
共有 20 例和 70 例患者分别归入 PJK+组和 PJK-组。PJK+组和 PJK-组术前和术后脊柱骨盆影像学参数无差异。PJK+组术前运动分析中平均前骨盆倾斜角（Ant-PT）明显高于 PJK-组（双侧 P=0.001）。多变量分析确定平均 Ant-PT 角（P=0.047；OR 1.127；95%CI 1.002-1.267）是急性 PJK 的显著危险因素。
术后急性 PJK 的 OR 与术前行走时的 Ant-PT 角相关。
