脊柱骨盆参数及相关因素对后路内固定后近端置钉骨折的影响。
The Influences of Spinopelvic Parameters and Associated Factors on Development of Proximal Instrumented Fracture After Posterior Instrumentation.
机构信息
Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Department of Orthopedics Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
出版信息
World Neurosurg. 2022 Jan;157:e308-e315. doi: 10.1016/j.wneu.2021.10.070. Epub 2021 Oct 11.
OBJECTIVE
To investigate influences of spinopelvic parameters, such as lumbar lordosis (LL) angles, pelvic incidence, sacral slope, pelvic tilt, and sagittal vertical axis, on development of the proximal junctional failure fracture type after posterior instrumentation.
METHODS
This retrospective 1:3 matched case-control cohort study included 24 patients who developed proximal instrumented fracture in the study group and 72 patients without proximal junctional failure in the control group. Weighted Charlson Comorbidity Index and bone mineral density with T-score were recorded. In addition to spinopelvic parameters, proximal local kyphosis (PLK), which refers to a kyphosis angle between the upper end plate of upper instrumented vertebra plus 1 level and the lower end plate of upper instrumented vertebra; pelvic incidence-LL mismatch; and spinopelvic realignment score were calculated.
RESULTS
More comorbidities (Charlson Comorbidity Index, P = 0.002) and poorer bone density (T-score, P = 0.001) were noted in the study group. Before surgery, the study group had significantly lower LL (P = 0.046) and sacral slope (P = 0.043) and significantly higher PLK (P < 0.001) and pelvic tilt (P = 0.044) than the control group. Postoperatively, the study group had significantly higher PLK (P < 0.001) and lower LL (P = 0.031) than the control group; the degree of pelvic incidence-LL mismatch (P = 0.007) remained significantly higher in the study group. Preoperative (P = 0.026) and postoperative (P = 0.045) spinopelvic realignment scores was worse in the study group. Multivariate analysis revealed that postoperative PLK was the most significant radiographic factor to predict proximal instrumented fracture (P = 0.002, odds ratio 1.140, 95% confidence interval).
CONCLUSIONS
In our experience, appropriate LL and lower PLK should be obtained at surgery to prevent development of instrumented fracture.
目的
研究脊柱骨盆参数（如腰椎前凸角、骨盆入射角、骶骨倾斜角、骨盆倾斜度和矢状垂直轴）对后路内固定后近端交界性失败骨折类型的影响。
方法
本回顾性 1:3 匹配病例对照队列研究纳入了 24 例研究组中发生近端器械性骨折的患者和 72 例对照组中无近端交界性失败的患者。记录加权 Charlson 合并症指数和 T 评分骨密度。除脊柱骨盆参数外，还计算了近端局部后凸角（PLK），即上固定椎体上终板加 1 个椎体的后凸角与上固定椎体下终板之间的角度；骨盆入射角-腰椎前凸角不匹配；和脊柱骨盆矫正评分。
结果
研究组的合并症（Charlson 合并症指数，P=0.002）和骨密度较差（T 评分，P=0.001）。术前，研究组的腰椎前凸角（P=0.046）和骶骨倾斜角（P=0.043）明显较低，PLK（P<0.001）和骨盆倾斜度（P=0.044）明显较高。术后，研究组的 PLK（P<0.001）明显较高，LL（P=0.031）明显较低；研究组的骨盆入射角-腰椎前凸角不匹配程度（P=0.007）仍明显较高。术前（P=0.026）和术后（P=0.045）脊柱骨盆矫正评分较差。多变量分析显示，术后 PLK 是预测近端器械性骨折的最显著影像学因素（P=0.002，优势比 1.140，95%置信区间）。
结论
根据我们的经验，术中应获得适当的腰椎前凸角和较低的 PLK，以预防器械性骨折的发生。
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