建立老年慢性骨质疏松性椎体骨折(COVF)后路内固定术后近端交界性脊柱后凸(PJK)预测评分系统。
回顾性分析2013年1月至2017年12月在我院确诊为COVF并接受后路内固定术的88例患者的病历资料。根据患者术后是否发生PJK分为两组,即,PJK组25例,非PJK组63例。记录并分析了以下临床特征:年龄,性别,体重指数(BMI),骨矿物质密度(BMD),吸烟史,骨折段,近端连接角度,矢状椎体轴,骨盆发病率(PI)-腰椎前凸(LL),骨盆倾斜(PT),骶骨斜坡(SS),后韧带复合体(PLC)损伤,上器械椎骨,下部器械椎骨,和固定段的数量。评估了PJK组中这些临床特征的患病率,并采用logistic回归分析建立评分体系。评分系统的性能也得到了前瞻性验证。
根据被证实为PJK的重要预测因子的五个临床特征,建立了预测评分系统。即,年龄>70岁,BMI>28kg/m2,BMD<-3.5SD,术前PI-LL>20°,PLC损伤。PJK的得分明显高于非PJK(7.80分vs.2.83分,t=9.556,P<0.001),评分系统的最佳临界值为5分。评分系统对术后PJK预测的敏感性和特异性分别为80.00%和88.89%,分别,在推导集中,在验证集中为75.00%和80.00%。
预测评分系统对老年COVF患者后路内固定术后PJK的预测具有满意的敏感性和特异性。6-11分的患者术后发生PJK的风险较高,而0-5的分数很低。
To establish a predictive scoring system for proximal junctional kyphosis (PJK) after posterior internal fixation in elderly patients with chronic osteoporotic vertebral fracture (COVF).
The medical records of 88 patients who were diagnosed with COVF and underwent posterior internal fixation in our hospital from January 2013 to December 2017 were retrospectively analyzed. The included patients were divided into two groups according to whether they suffered PJK after surgery, namely, the PJK group (25 cases) and non-PJK group (63 cases). The following clinical characteristics were recorded and analyzed: age, gender, body mass index (BMI), bone mineral density (BMD), smoking history, fracture segment, proximal junction angle, sagittal vertebral axis, pelvic incidence (PI)-lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), posterior ligamentous complex (PLC) injury, upper instrumented vertebra, lower instrumented vertebra, and the number of fixed segments. The prevalence of these clinical characteristics in the PJK group was evaluated, and the scoring system was established using logistic regression analysis. The performance of the scoring system was also prospectively validated.
The predictive scoring system was established based on five clinical characteristics confirmed as significant predictors of PJK, namely, age > 70 years, BMI > 28 kg/m2, BMD < -3.5 SD, preoperative PI-LL > 20°, and PLC injury. PJK showed a significantly higher score than non-PJK (7.80 points vs. 2.83 points, t=9.556, P<0.001), and the optimal cutoff value for the scoring system was 5 points. The sensitivity and specificity of the scoring system for predicting postoperative PJK were 80.00% and 88.89%, respectively, in the derivation set and 75.00% and 80.00% in the validation set.
The predictive scoring system was confirmed with satisfactory sensitivity and specificity in predicting PJK after posterior internal fixation in elderly COVF patients. The risk of postoperative PJK in patients with a score of 6-11 is high, while the score of 0-5 is low.