CAJ | 학술논문

目的：探讨脊柱后凸畸形截骨矫形术后近端交界性后凸( PJK)的发生率、相关危险因素及其预防方法。方法选取2005年1月-2009年1月西安市红会医院收治的87例脊柱胸腰段后凸畸形患者,年龄11~20岁,平均14.8岁,均行后路截骨矫形术,观察其近端交界区后凸角度的变化情况。分别在术前、术后3月和末次随访时,记录患者影像学参数。结果所有患者均获得随访,随访时间5~9年,平均6.4年。87例中,24例(27.6%)术后发生PJK(PJK组),且在随访过程中,有加重的趋势,其中3例局部疼痛明显,1例再次手术；余63例归入非PJK组。末次随访时,PJK组近端交界区后凸角度为17.5°±2.6°,非PJK组为7.1°±2.6°,两组比较差异有统计学意义(P<0.05)。两组患者年龄、近端融合范围、近端交界区后凸角度、术后全脊柱矢状位平衡以及术前术后矢状面平衡距离纠正程度比较,差异均有统计学意义(P值均<0.05)。结论脊柱后凸畸形后路截骨矫形术后PJK发生率为27.6%,其相关的危险因素包括年龄、近端融合范围、近端交界区后凸角度、术后全脊柱矢状位平衡以及术前术后矢状面平衡距离纠正程度。
목적：탐토척주후철기형절골교형술후근단교계성후철( PJK)적발생솔、상관위험인소급기예방방법。방법선취2005년1월-2009년1월서안시홍회의원수치적87례척주흉요단후철기형환자,년령11~20세,평균14.8세,균행후로절골교형술,관찰기근단교계구후철각도적변화정황。분별재술전、술후3월화말차수방시,기록환자영상학삼수。결과소유환자균획득수방,수방시간5~9년,평균6.4년。87례중,24례(27.6%)술후발생PJK(PJK조),차재수방과정중,유가중적추세,기중3례국부동통명현,1례재차수술；여63례귀입비PJK조。말차수방시,PJK조근단교계구후철각도위17.5°±2.6°,비PJK조위7.1°±2.6°,량조비교차이유통계학의의(P<0.05)。량조환자년령、근단융합범위、근단교계구후철각도、술후전척주시상위평형이급술전술후시상면평형거리규정정도비교,차이균유통계학의의(P치균<0.05)。결론척주후철기형후로절골교형술후PJK발생솔위27.6%,기상관적위험인소포괄년령、근단융합범위、근단교계구후철각도、술후전척주시상위평형이급술전술후시상면평형거리규정정도。
Objective To evaluate the incidence, risk factors and prevention methods of proximal junctional kyphosis ( PJK) after posterior osteotomy in adolescent spine kyphosis. Methods A total of 87 patients with adolescent spine kyphosis were performed posterior osteotomy in Xi′an Honghui Hospital between January 2005 and January 2009, with the average age of 14. 8 years old (range from 11 to 20 years old) . The change of the proximal junction angle was recorded before operation, 3 months after operation and the last follow up time. Results All patients were followed up for an average time of 6. 4 years (range from 5 to 9 years). There were 27. 6% patients (24/87) developed into PJK, and there was an increasing trend during the follow up time. There was 3 patients suffered from back pain, and one of them was performed revision. At the last followed time, the angles in PJK group and non-PJK group were 17. 5° ± 2. 6° and 7. 1° ± 2. 6°, respectively. The risk factors related to the PJK included age, proximal fusion range, pre-operative PJK angle, inappropriate global spine alignment and greater sagittal vertical axis change. There was a significant difference between these two groups(all P values<0. 05). Conclusions The incidence of PJK of posterior osteotomy in adolescent spine kyphosis is approxomately 27. 6%. The age, proximal fusion range, pre-operative PJK angle, inappropriate global spine alignment and greater sagittal vertical axis change are significant risk factors for PJK.