Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, No.555, Youyi East Road, Xi'an, Shaanxi, China.
BMC Surg. 2022 May 14;22(1):189. doi: 10.1186/s12893-022-01598-9.
This study aimed to analyze the risk factors for proximal junctional kyphosis (PJK) for patients with chronic symptomatic osteoporotic thoracolumbar fractures (CSOTLF) and kyphosis who underwent long-segment internal fixation.
We retrospectively reviewed the records of patients with CSOTLF complicated with kyphosis who underwent posterior multilevel internal fixation in our hospital between January 2013 and January 2020. The patients' age, sex, body mass index (BMI), bone mineral density (BMD), smoking status, cause of injury, comorbidities, injury segments, and American Spinal Injury Association (ASIA) grading non-surgical data; posterior ligament complex (PLC) injury, upper and lower instrumented vertebral position (UIV and LIV, respectively), number of fixed segments surgical data, proximal junctional angle (PJA), sagittal vertebral axis (SVA), pelvic incidence (PI), lumbar lordosis (LL), pelvic incidence-lumbar lordosis mismatch (PI-LL), pelvic tilt (PT), and sacral slope (SS) surgical indicators were collected. Patients were divided into postoperative PJK and non-PJK groups.
This study included 90 patients; among them, 30 (31.58%) developed PJK postoperatively. All patients were followed up for > 24 months (mean 32.5 months). Univariate analysis showed significant differences in age, BMI, BMD, PLC injury, UIV, and LIV fixation position, number of fixation stages, and preoperative PJA, SVA, PI-LL, and SS between the two groups (P < 0.05). Additionally, no significant differences were observed in sex, smoking, cause of injury, complications, injury segment ASIA grade, and preoperative PT between the two groups (P > 0.05). Multifactorial logistic regression analysis showed that age > 70 years (OR = 32.279, P < 0.05), BMI > 28 kg/m (OR = 7.876, P < 0.05), BMD T value < - 3.5 SD (OR = 20.836, P < 0.05), PLC injury (OR = 13.981, P < 0.05), and preoperative PI-LL > 20° (OR = 13.301, P < 0.05) were risk factors for PJK after posterior long-segment internal fixation in elderly patients with CSOTLF complicated with kyphosis.
CSOTLF patients undergoing posterior long segment internal fixation are prone to PJK, and age > 70 years, BMI > 28 kg/m2, BMD T value < - 3.5 SD, preoperative PI-LL > 20° and PLC injury may increase their risk.
本研究旨在分析长节段内固定治疗慢性症状性骨质疏松性胸腰椎骨折（CSOTLF）合并后凸畸形患者发生近端交界性后凸（PJK）的危险因素。
回顾性分析 2013 年 1 月至 2020 年 1 月我院收治的 CSOTLF 合并后凸行后路多节段内固定的患者。收集患者的年龄、性别、体重指数（BMI）、骨密度（BMD）、吸烟状况、损伤原因、合并症、损伤节段、美国脊柱损伤协会（ASIA）分级非手术资料；后路韧带复合体（PLC）损伤、上下固定椎体位置（UIV 和 LIV）、固定节段数手术资料，近端交界角（PJA）、矢状椎体轴（SVA）、骨盆入射角（PI）、腰椎前凸（LL）、骨盆入射角-腰椎前凸不匹配（PI-LL）、骨盆倾斜（PT）和骶骨倾斜（SS）手术指标。患者分为术后 PJK 组和非 PJK 组。
本研究共纳入 90 例患者；其中 30 例（31.58%）术后发生 PJK。所有患者的随访时间均超过 24 个月（平均 32.5 个月）。单因素分析显示，两组间年龄、BMI、BMD、PLC 损伤、UIV 和 LIV 固定位置、固定节段数、术前 PJA、SVA、PI-LL 和 SS 差异有统计学意义（P<0.05）。两组间性别、吸烟、损伤原因、并发症、损伤节段 ASIA 分级、术前 PT 差异无统计学意义（P>0.05）。多因素 logistic 回归分析显示，年龄>70 岁（OR=32.279，P<0.05）、BMI>28kg/m2（OR=7.876，P<0.05）、BMD T 值<-3.5SD（OR=20.836，P<0.05）、PLC 损伤（OR=13.981，P<0.05）和术前 PI-LL>20°（OR=13.301，P<0.05）是 CSOTLF 合并后凸行后路长节段内固定术后发生 PJK 的危险因素。
CSOTLF 患者行后路长节段内固定易发生 PJK，年龄>70 岁、BMI>28kg/m2、BMD T 值<-3.5SD、术前 PI-LL>20°和 PLC 损伤可能增加其风险。
