背景:我们试图确定上器械椎骨(UIV)的哪个方面-倾斜角或螺钉角-与:(1)近端交界性脊柱后凸/失败(PJK/F),(2)其他机械并发症和再次手术,和(3)患者报告的结果测量(PROMs)。
方法:单一机构,我们从2011年至2017年对接受成人脊柱畸形(ASD)手术的患者进行了回顾性队列研究.仅包括在T7或以下具有UIV的患者。主要的暴露变量是UIV倾角(UIV下端板和水平的角度)和UIV螺钉角度(UIV螺钉和上端板的角度)。多变量逻辑回归包括年龄,身体质量指数,骨质减少/骨质疏松症,术后矢状面垂直轴,术后骨盆发病率腰椎前凸不匹配,UIV倾斜角度,和UIV螺丝角度。
结果:共有117例患者接受了成人脊柱畸形手术,至少随访2年。共有41例(35.0%)患有PJK,26例(22.2%)患有PJF。(1)UIV倾角:96(82.1%)具有脊柱前凸UIV倾角,6人(5.1%)为中性,15例(12.8%)为后凸畸形。(2)UIV螺钉角度:38(32.5%)有头颅螺钉,4(3.4%)为中性,75例(64.1%)为尾部定向。前凸角度UIV终板(OR=1.06,95%CI=1.01-1.12,P=0.020)和头颅螺钉(OR=1.19,95%CI=1.07-1.33,P<0.001)与较高的PJK几率相关,与UIV倾斜角度相比,UIV螺旋角度的影响更明显(Wald试验,9.40vs4.42)。对于PJF也发现了类似的结果。这两个参数都与其他机械性并发症有关,重新操作,或患者报告的结果指标。
结论:与倾斜角度相比,UIV螺旋角度与PJK/F的发展更密切相关。总的来说,这些可修改的参数直接在外科医生的控制下,可以减轻PJK/F的发展。
结论:当在下胸部或腰部区域进行UIV的ASD手术时,外科医生可能会考虑选择具有中性或后凸定向UIV倾斜角的UIV,以及使用尾向的UIV螺旋角,降低患PJK/F的风险
方法:
BACKGROUND: We sought to determine which aspect of the upper instrumented vertebrae (UIV)-tilt angle or screw angle-was more strongly associated with: (1) proximal junctional kyphosis/failure (PJK/F), (2) other mechanical complications and reoperations, and (3) patient-reported outcome measures (PROMs).
METHODS: A single-institution, retrospective cohort study was undertaken for patients undergoing adult spinal deformity (ASD) surgery from 2011 to 2017. Only patients with UIV at T7 or below were included. The primary exposure variables were UIV tilt angle (the angle of the UIV inferior endplate and the horizontal) and UIV screw angle (the angle of the UIV screws and superior endplate). Multivariable logistic regression included age, body mass index, osteopenia/osteoporosis, postoperative sagittal vertical axis, postoperative pelvic-incidence lumbar lordosis mismatch, UIV tilt angle, and UIV screw angle.
RESULTS: One hundred and seventeen patients underwent adult spinal deformity surgery with a minimum of 2-year follow-up. A total of 41 patients (35.0%) had PJK and 26 (22.2%) had PJF. (1) UIV tilt angle: 96 (82.1%) had lordotic UIV tilt angles, 6 (5.1%) were neutral, and 15 (12.8%) were kyphotic. (2) UIV screw angle: 38 (32.5%) had cranially directed screws, 4 (3.4%) were neutral, and 75 (64.1%) were caudally directed. Both lordotic-angled UIV endplate (OR = 1.06, 95% CI = 1.01-1.12, and P = 0.020) and cranially directed screws (OR = 1.19, 95% CI = 1.07-1.33, and P < 0.001) were associated with higher odds of PJK, with a more pronounced effect of UIV screw angle compared with UIV tilt angle (Wald test, 9.40 vs 4.42). Similar results were found for PJF. Neither parameter was associated with other mechanical complications, reoperations, or patient-reported outcome measures.
CONCLUSIONS: UIV screw angle was more strongly associated with development of PJK/F compared with tilt angle. Overall, these modifiable parameters are directly under the surgeon\'s control and can mitigate the development of PJK/F.
CONCLUSIONS: Surgeons may consider selecting a UIV with a neutral or kyphotically directed UIV tilt angle when performing ASD surgery with a UIV in the lower thoracic or lumbar region, as well as use UIV screw angles that are caudally directed, for the purprose of decreasing the risk of developing PJK/F.
METHODS: