1Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hatsukaichi, Japan; and.
2Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
J Neurosurg Spine. 2023 Mar 31;39(1):75-81. doi: 10.3171/2023.2.SPINE2392. Print 2023 Jul 1.
The authors aimed to determine the poor prognostic factors of balloon kyphoplasty for the treatment of fractures of the most distal or distal-adjacent vertebrae in ankylosing spines with diffuse idiopathic skeletal hyperostosis (DISH).
Eighty-nine patients with fractures of the most distal or distal-adjacent vertebrae of ankylosing spines with DISH were included and divided into two groups: those with (n = 51) and without (n = 38) bone healing 6 months postoperatively. Clinical evaluation included age, sex, time from onset to surgery, the visual analog scale score for low-back pain, and the Oswestry Disability Index (ODI). The VAS scores and ODI were measured both preoperatively and at 6 months postoperatively. Radiological evaluations included bone density; wedge angles of the fractured vertebrae in the supine and sitting positions on lateral radiographs; differences in the wedge angles (change in wedge angle); and the amount of polymethylmethacrylate used.
The preoperative ODI, vertebral wedge angles in the supine and sitting positions, change in wedge angle, and amount of polymethylmethacrylate were significantly different between the two groups and were significantly associated with delayed bone healing in univariate logistic regression analysis. Multivariate logistic regression analysis showed that only a change in the wedge angle was significantly associated with delayed healing, with a cutoff value of 10°, sensitivity of 84.2%, and specificity of 82.4%.
Treatment with balloon kyphoplasty alone should be avoided in patients with a difference ≥ 10° in the wedge angle of the fractured vertebrae between the supine and sitting positions.
本研究旨在探讨强直性脊柱炎伴弥漫性特发性骨肥厚（DISH）患者脊柱最远端或相邻远端骨折行球囊后凸成形术的不良预后因素。
共纳入 89 例强直性脊柱炎伴 DISH 脊柱最远端或相邻远端骨折患者，根据术后 6 个月是否有骨愈合将患者分为两组：骨愈合组（n=51）和未愈合组（n=38）。临床评估包括年龄、性别、发病至手术时间、腰痛视觉模拟评分（VAS）和 Oswestry 功能障碍指数（ODI）。术前和术后 6 个月均测量 VAS 评分和 ODI。影像学评估包括骨密度；仰卧位和坐位侧位 X 线片上骨折椎体的楔形角；楔形角的差异（楔形角变化）；以及使用的聚甲基丙烯酸甲酯（PMMA）量。
两组间术前 ODI、仰卧位和坐位时的椎体楔形角、楔形角变化和 PMMA 用量均有显著差异，且在单因素逻辑回归分析中与骨愈合延迟显著相关。多因素逻辑回归分析显示，只有楔形角变化与愈合延迟显著相关，截断值为 10°，敏感性为 84.2%，特异性为 82.4%。
对于仰卧位和坐位时骨折椎体楔形角差值≥10°的患者，应避免单独行球囊后凸成形术治疗。
