Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY.
Spine (Phila Pa 1976). 2024 Mar 15;49(6):405-411. doi: 10.1097/BRS.0000000000004828. Epub 2023 Sep 12.
Retrospective review of an adult deformity database.
To identify pelvic incidence (PI) and age-appropriate physical function alignment targets using a component angle of T1-pelvic angle within the fusion to define correction and their relationship to proximal junctional kyphosis (PJK) and clinical outcomes.
In preoperative planning, a patient's PI is often utilized to determine the alignment target. In a trend toward more patient-specific planning, age-specific alignment has been shown to reduce the risk of mechanical failures. PI and age have not been analyzed with respect to defining a functional alignment.
A database of patients with operative adult spinal deformity was analyzed. Patients fused to the pelvis and upper-instrumented vertebrae above T11 were included. Alignment within the fusion correlated with clinical outcomes and PI. Short form 36-Physical Component Score (SF36-PCS) normative data and PI were used to compute functional alignment for each patient. Overcorrected, under-corrected, and functionally corrected groups were determined using T10-pelvic angle (T10PA).
In all, 1052 patients met the inclusion criteria. T10PA correlated with SF36-PCS and PI (R=0.601). At six weeks, 40.7% were functionally corrected, 39.4% were overcorrected, and 20.9% were under-corrected. The PJK incidence rate was 13.6%. Overcorrected patients had the highest PJK rate (18.1%) compared with functionally (11.3%) and under-corrected (9.5%) patients ( P <0.05). Overcorrected patients had a trend toward more PJK revisions. All groups improved in HRQL; however, under-corrected patients had the worst 1-year SF36-PCS offset relative to normative patients of equivalent age (-8.1) versus functional (-6.1) and overcorrected (-4.5), P <0.05.
T10PA was used to determine functional alignment, an alignment based on PI and age-appropriate physical function. Correcting patients to functional alignment produced improvements in clinical outcomes, with the lowest rates of PJK. This patient-specific approach to spinal alignment provides adult spinal deformity correction targets that can be used intraoperatively.
成人畸形数据库的回顾性研究。
通过融合内 T1-骨盆角的组成角度来确定骨盆入射角（PI）和适合年龄的物理功能对准目标，以定义矫正效果，并研究其与近端交界性后凸（PJK）和临床结果的关系。
在术前规划中，患者的 PI 常被用来确定对准目标。随着患者特异性规划的趋势，特定年龄的对准已被证明可降低机械失效的风险。PI 和年龄尚未针对功能对准进行分析。
分析了患有手术成人脊柱畸形的患者数据库。纳入了融合至骨盆并在上位器械椎骨 T11 以上的患者。融合内的对准与临床结果和 PI 相关。将 SF36-物理成分评分（SF36-PCS）的简表和 PI 用于计算每位患者的功能对准。使用 T10-骨盆角（T10PA）确定过度矫正、不足矫正和功能矫正组。
共有 1052 名患者符合纳入标准。T10PA 与 SF36-PCS 和 PI 相关（R=0.601）。在 6 周时，40.7%的患者功能矫正，39.4%的患者过度矫正，20.9%的患者不足矫正。PJK 的发生率为 13.6%。与功能矫正（11.3%）和不足矫正（9.5%）患者相比，过度矫正患者的 PJK 发生率最高（18.1%）（P<0.05）。过度矫正患者有更多的 PJK 翻修趋势。所有组的 HRQL 均有所改善；然而，与同龄的标准患者相比，不足矫正患者的 SF36-PCS 偏移量在 1 年时最差（-8.1），而功能矫正（-6.1）和过度矫正（-4.5）患者（P<0.05）。
使用 T10PA 确定了功能对准，这是一种基于 PI 和适合年龄的物理功能的对准。将患者矫正至功能对准可改善临床结果，且 PJK 发生率最低。这种针对脊柱的患者特异性方法提供了可用于术中的成人脊柱畸形矫正目标。
