Boeckenfoerde Kathrin, Schulze Boevingloh Albert, Gosheger Georg, Bockholt Sebastian, Lampe Lukas Peter, Lange Tobias
Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, 48149 Muenster, Germany.
Department of Orthopedics and Trauma Surgery, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany.
J Clin Med. 2022 Oct 16;11(20):6098. doi: 10.3390/jcm11206098.
Proximal junctional kyphosis (PJK), as one of the most discussed problems after corrective surgery in adolescent idiopathic scoliosis (AIS), is still not fully clarified and seems to be multifactorial. Biomechanical and a few clinical studies have shown the influence of destruction of posterior ligaments by resection of spinous processes and some parameters concerning rod contouring as risk factors for PJK. To verify these results, 192 patients with AIS and corrective surgery via a posterior approach between 2009 and 2017 were included. Radiographic parameters were analyzed preoperatively (preOP), postoperatively (postOP), and with a mean follow up (FU) of 27 months. The participants were divided into two groups (PJK group and non-PJK group). The incidence of PJK was 15.6%. Contrary to the results of biomechanical studies, we could not find any significant influence of the spinous process resection. However, the PJK group had significantly larger preOP T4-T12 kyphosis (31.1° ± 13.93° vs. 23.3° ± 14.93°, = 0.016). Furthermore, the PJK group showed a significantly larger rod contour angle (RCA) (8.0° ± 4.44° vs. 5.9° ± 3.28°, = 0.003) and mismatch of postOP proximal junctional angle (PJA) and RCA (3.5° ± 5.72° vs. 0.9° ± 4.86°, = 0.010) compared to the non-PJK group. An increase in the mismatch of postOP PJA and RCA (OR = 1.14, = 0.008) and a high RCA are risk factors for PJK and need to be focused on by surgeons.
近端交界性后凸（PJK）是青少年特发性脊柱侧凸（AIS）矫正手术后讨论最多的问题之一，目前仍未完全阐明，似乎是多因素导致的。生物力学和一些临床研究表明，棘突切除导致后韧带破坏以及一些与棒材塑形有关的参数是PJK的危险因素。为了验证这些结果，纳入了2009年至2017年间192例行后路矫正手术的AIS患者。对术前（preOP）、术后（postOP）以及平均随访27个月（FU）时的影像学参数进行了分析。将参与者分为两组（PJK组和非PJK组）。PJK的发生率为15.6%。与生物力学研究结果相反，我们未发现棘突切除有任何显著影响。然而，PJK组术前T4 - T12后凸明显更大（31.1°±13.93° vs. 23.3°±14.93°，P = 0.016）。此外，与非PJK组相比，PJK组的棒材塑形角度（RCA）明显更大（8.0°±4.44° vs. 5.9°±3.28°，P = 0.003），术后近端交界角（PJA）与RCA的不匹配度也更大（3.5°±5.72° vs. 0.9°±4.86°，P = 0.010）。术后PJA与RCA不匹配度增加（OR = 1.14，P = 0.008）和高RCA是PJK的危险因素，外科医生需要予以关注。
