目的:分析青少年特发性脊柱侧凸(AIS)矫正手术后发生近端交界性脊柱后凸(PJK)的危险因素。
方法:PubMed,Medline,Embase,科克伦图书馆,WebofScience,CNKI,和EMCC数据库被搜索的回顾性研究利用所有AIS患者PJK矫正手术后收集术前,术后,和后续成像参数,包括胸椎后凸(TK),腰椎前凸(LL),近端连接角(PJA),矢状垂直轴(SVA),骨盆发病率(PI),骨盆倾斜(PT),骨盆发病率-腰椎前凸(PI-LL),骶骨斜坡(SS),杆轮廓角度(RCA)和上器械椎骨(UIV)。
结果:本荟萃分析包括19项回顾性研究,其中干预组550例,对照组3456例。总的来说,性别(OR1.40,95%CI(1.08,1.83),P=0.01),术前TK较大(WMD6.82,95%CI(5.48,8.16),P<0.00001),较大的随访TK(WMD8.96,95%CI(5.62,12.30),P<0.00001),术后LL较大(WMD2.31,95%CI(0.91,3.71),P=0.001),较大的随访LL(WMD2.51,95%CI(1.19,3.84),P=0.0002),LL(WMD-2.72,95%CI(-4.69,-0.76),P=0.006),术后PJA较大(WMD4.94,95%CI(3.62,6.26),P<0.00001),更大的随访PJA(WMD13.39,95%CI(11.09,15.69),P<0.00001),术后PI-LL较大(WMD-9.57,95%CI(-17.42,-1.71),P=0.02),更大的随访PI-LL(WMD-12.62,95%CI(-17.62,-7.62),P<0.00001),术前SVA较大(WMD0.73,95%CI(0.26,1.19),P=0.002),术前SS较大(WMD-3.43,95%CI(-4.71,-2.14),P<0.00001),RCA(大规模杀伤性武器1.66,95%CI(0.48,2.84),P=0.006)被确定为AIS患者PJK的危险因素。对于Lenke5AIS患者,术前TK较大(WMD7.85,95%CI(5.69,10.00),P<0.00001),术后TK较大(WMD9.66,95%CI(1.06,18.26),P=0.03,随访TK较大(WMD11.92,95%CI(6.99,16.86),P<0.00001,术前PJA较大(WMD0.72,95%CI(0.03,1.41),P=0.04,术后PJA较大(WMD5.54,95%CI(3.57,7.52),P<0.00001),更大的随访PJA(WMD12.42,95%CI9.24,15.60),P<0.00001,随访SVA较大(WMD0.07,95%CI(-0.46,0.60),P=0.04),术前PT较大(WMD-3.04,95%CI(-5.27,-0.81),P=0.008,更大的随访PT(WMD-3.69,95%CI(-6.66,-0.72),P=0.02)被确定为PJK的危险因素。
结论:矫正手术后,19%的AIS患者经历过PJK,Lenke5贡献了25%。术前和术后测量在预测PJK发生方面起着重要作用;因此,一丝不苟,个性化的术前计划至关重要。这包括考虑基于Lenke分类的个性化治疗作为我们未来的评估标准。
OBJECTIVE: To analyze the risk factors of proximal junctional kyphosis (PJK) after correction surgery in patients with adolescent idiopathic scoliosis (AIS).
METHODS: PubMed, Medline, Embase, Cochrane Library, Web of Science, CNKI, and EMCC databases were searched for retrospective studies utilizing all AIS patients with PJK after corrective surgery to collect preoperative, postoperative, and follow-up imaging parameters, including thoracic kyphosis (TK), lumbar lordosis (LL), proximal junctional angle (PJA), the sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), pelvic incidence-lumbar lordosis (PI-LL), sacral slope (SS), rod contour angle (RCA) and upper instrumented vertebra (UIV).
RESULTS: Nineteen retrospective studies were included in this meta-analysis, including 550 patients in the intervention group and 3456 patients in the control group. Overall, sex (OR 1.40, 95% CI (1.08, 1.83), P = 0.01), larger preoperative TK (WMD 6.82, 95% CI (5.48, 8.16), P < 0.00001), larger follow-up TK (WMD 8.96, 95% CI (5.62, 12.30), P < 0.00001), larger postoperative LL (WMD 2.31, 95% CI (0.91, 3.71), P = 0.001), larger follow-up LL (WMD 2.51, 95% CI (1.19, 3.84), P = 0.0002), great change in LL (WMD - 2.72, 95% CI (- 4.69, - 0.76), P = 0.006), larger postoperative PJA (WMD 4.94, 95% CI (3.62, 6.26), P < 0.00001), larger follow-up PJA (WMD 13.39, 95% CI (11.09, 15.69), P < 0.00001), larger postoperative PI-LL (WMD - 9.57, 95% CI (- 17.42, - 1.71), P = 0.02), larger follow-up PI-LL (WMD - 12.62, 95% CI (- 17.62, - 7.62), P < 0.00001), larger preoperative SVA (WMD 0.73, 95% CI (0.26, 1.19), P = 0.002), larger preoperative SS (WMD - 3.43, 95% CI (- 4.71, - 2.14), P < 0.00001), RCA (WMD 1.66, 95% CI (0.48, 2.84), P = 0.006) were identified as risk factors for PJK in patients with AIS. For patients with Lenke 5 AIS, larger preoperative TK (WMD 7.85, 95% CI (5.69, 10.00), P < 0.00001), larger postoperative TK (WMD 9.66, 95% CI (1.06, 18.26), P = 0.03, larger follow-up TK (WMD 11.92, 95% CI (6.99, 16.86), P < 0.00001, larger preoperative PJA (WMD 0.72, 95% CI (0.03, 1.41), P = 0.04, larger postoperative PJA (WMD 5.54, 95% CI (3.57, 7.52), P < 0.00001), larger follow-up PJA (WMD 12.42, 95% CI 9.24, 15.60), P < 0.00001, larger follow-up SVA (WMD 0.07, 95% CI (- 0.46, 0.60), P = 0.04), larger preoperative PT (WMD - 3.04, 95% CI (- 5.27, - 0.81), P = 0.008, larger follow-up PT (WMD - 3.69, 95% CI (- 6.66, - 0.72), P = 0.02) were identified as risk factors for PJK.
CONCLUSIONS: Following corrective surgery, 19% of AIS patients experienced PJK, with Lenke 5 contributing to 25%. Prior and post-op measurements play significant roles in predicting PJK occurrence; thus, meticulous, personalized preoperative planning is crucial. This includes considering individualized treatments based on the Lenke classification as our future evaluation standard.