Ni Jiajun, Yan Shi, Li Yangxiao, Chen Zhongqiang, Zeng Yan
Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China.
Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China.
Eur Spine J. 2025 Apr 28. doi: 10.1007/s00586-025-08883-0.
To investigate the effectiveness of sagittal deformity angular distance ratio (S-DADR; sagittal Cobb angle divided by the distance, in centimeters, between the midpoint of the upper endplate of the upper end vertebrae and the midpoint of the lower endplate of the lower end vertebrae) in evaluating neurological risks in patients with post-tuberculous kyphosis (PTK).
A consecutive series of 102 patients with PTK who underwent corrective surgery between September 2010 and June 2024 were included. Measurements derived from preoperative radiographs were utilized to compute S-DADR. Potential risk factors of postoperative neurological deficits (PNDs) were assessed through univariate and multivariate analyses. Binary logistic regression was used to model the relationship between identified independent risk factors and PNDs, and the model was evaluated by the area under receiver operating characteristic curve (AUC).
The mean age of the 102 patients was 49.5 ± 12.1 years, and the incidence of PNDs was 22.5%. Univariate logistic regression revealed a positive correlation between the incidence of PNDs and S-DADR (OR = 1.103, P = 0.003), preoperative sagittal Cobb angle (OR = 1.025, P = 0.007), number of vertebrae resected (OR = 1.661, P = 0.024), operative time (OR = 1.005, P = 0.048) and total instrumented vertebrae (OR = 1.391, P = 0.014). Multivariate logistic regression identified S-DADR (OR = 1.091, P = 0.025) as an independent factor of PNDs. Patients with S-DADR ≥ 21.4 exhibited a 30% incidence of PNDs, which increased to 50% with an S-DADR of 30.0. The overall predictive performance of S-DADR (AUC = 0.720) for PNDs was deemed satisfactory.
S-DADR can be used to quantify the severity of the deformity in patients with PTK, which is an independent risk factor for PNDs during corrective surgery. Patients with S-DADR ≥ 21.4 face a 30% incidence of developing PNDs after corrective surgery.
探讨矢状面畸形角距比（S-DADR；矢状面Cobb角除以上端椎上终板中点与下端椎下终板中点之间的距离，单位为厘米）在评估结核后凸畸形（PTK）患者神经风险中的有效性。
纳入2010年9月至2024年6月期间连续接受矫正手术的102例PTK患者。利用术前X线片测量值计算S-DADR。通过单因素和多因素分析评估术后神经功能缺损（PND）的潜在危险因素。采用二元逻辑回归模型分析确定的独立危险因素与PND之间的关系，并通过受试者操作特征曲线下面积（AUC）评估模型。
102例患者的平均年龄为49.5±12.1岁，PND发生率为22.5%。单因素逻辑回归显示PND发生率与S-DADR（OR = 1.103，P = 0.003）、术前矢状面Cobb角（OR = 1.025，P = 0.007）、切除椎体数量（OR = 1.661，P = 0.024）、手术时间（OR = 1.005，P = 0.048）和总固定椎体数（OR = 1.391，P = 0.014）呈正相关。多因素逻辑回归确定S-DADR（OR = 1.091，P = 0.025）为PND的独立危险因素。S-DADR≥21.4的患者PND发生率为30%，当S-DADR为30.0时，发生率增至50%。S-DADR对PND的总体预测性能（AUC = 0.720）被认为是令人满意的。
S-DADR可用于量化PTK患者畸形的严重程度，是矫正手术期间PND的独立危险因素。S-DADR≥21.4的患者矫正手术后发生PND的发生率为30%。
