方法:回顾性病例对照研究。
目的:近端交界性脊柱后凸(PJK)是一种累及近端节段的术后并发症,常见于退行性脊柱疾病(DSD)患者。本研究的目的是确定老年DSD患者术后PJK的预测因素。
方法:我们回顾了接受了不少于3个级别的胸腰椎融合术的老年DSD患者。发生PJK的患者与接受相同程序但未发生PJK的DSD患者的倾向评分相匹配。人口特征,矢状垂直轴(SVA),计算机断层扫描(CT)值(Hounsfield单位),比较PJK和非PJK组的椎旁肌参数。
结果:通过年龄倾向评分匹配选择了83例PJK和非PJK患者,性别,吸烟史,身体质量指数,熔合段的数量,和上器械椎骨(UIV)位置。两组间SVA无显著差异。在PJK组中,竖脊肌和多裂肌的脂肪浸润(FI)明显更大,而竖脊肌的相对横截面积(rCSA)明显小于非PJK组。PJK组CT值明显降低。UIV的下直立脊髓rCSA和CT值,高竖脊肌FI和多裂肌FI被确定为术后PJK的预测因子。
结论:PJK是老年DSD患者的常见并发症。椎旁肌变性和UIV的低骨矿物质密度是PJK的预测因子。针对椎旁肌肉和UIV的保护措施可能有助于预防术后PJK。
METHODS: Retrospective
case-control study.
OBJECTIVE: Proximal junctional kyphosis (PJK) is a postoperative complication involving the proximal segments which is commonly seen in patients with degenerative spine diseases (DSD). The purpose of the present study was to identify predictive factors for postoperative PJK in elderly patients with DSD.
METHODS: We reviewed elderly patients with DSD who underwent thoracolumbar fusion involving no less than 3 levels. Patients who developed PJK were propensity score-matched with patients with DSD who received the same procedure but did not develop PJK. Demographic characteristics, sagittal vertical axis (SVA), computed tomography (CT) value (Hounsfield unit), and paraspinal muscle parameters were compared between PJK and non-PJK groups.
RESULTS: Eighty-three PJK and non-PJK patients were selected by propensity score matching for age, sex, history of smoking, body mass index, number of fused segments, and upper instrumented vertebra (UIV) location. SVA showed no significant difference between the two groups. In PJK group, fatty infiltration (FI) in erector spinae and multifidus was significantly greater, while the relative cross-sectional area (rCSA) of erector spinae was significantly smaller than that in non-PJK group. CT value was significantly lower in PJK group. Lower erector spinae rCSA and CT value of the UIV, higher erector spinae FI and multifidus FI were identified as predictors of postoperative PJK.
CONCLUSIONS: PJK is a common complication in older patients with DSD. Paraspinal muscle degeneration and low bone mineral density of the UIV are predictors of PJK. Protective measures targeting paraspinal muscles and the UIV may help prevent postoperative PJK.