腰椎退行性疾病行后路长节段固定融合术后近端交界性后凸的危险因素分析

发布时间：2018-02-28 15:43

本文关键词： 腰椎退行性疾病近端交界性后凸脊柱后凸　出处：《安徽医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的近端交界性后凸(proximal junctional kyphosis,PJK)是脊柱畸形矫形术后常见的并发症,严重时能造成神经压迫、脊髓损害等情况严重影响患者的生活质量。目前对PJK的发病机制及危险因素的研究尚无明确的定论,且以往的研究主要是关于青少年特发性脊柱畸形及成人脊柱畸形矫形术后PJK发生的相关报道,尚无文献对腰椎退行性疾病行后路行长节段固定融合术后发生PJK进行报道,基于这一现状,本文拟对腰椎退行性疾病行后路长节段固定融合术患者进行随访并探讨PJK的发生率及危险因素。方法回顾性研究2012年10月至2014年7月北京陆军总医院收治的118例因腰椎退变性疾病在我院脊柱外科行脊柱后路长节段内固定融合术的患者,至少随访1.5年。根据纳入标准和排除标准共入选66例资料完整的患者,平均随访3.2年,其中12例发生PJK归为PJK组,54例未发生PJK归为非PJK组。为了探讨PJK的危险因素,我们对三类因素进行了统计分析。(1)病人的一般资料:患者的性别、年龄、体质指数(body mass index,BMI)、骨密度(bone mineral density,BMD)。(2)外科手术因素:上端固定椎(upper instrumentation vertebrae,UIV)、下端固定椎(lower instrumented vertebra,LIV)、固定节段数。(3)影像学参数:腰椎前凸角(lumbar lordosis,LL),近端交界性后凸角(proximal junctional kyphosis angle,PJKA)。为了评估两组患者症状的严重程度,我们对术前及末次随访ODI进行了统计分析。结果66例患者随访中12例发生PJK,归为PJK组,54例没有发生PJK的患者,归为非PJK组。在本研究中PJK的发生率为18.18%。两组患者性别、年龄比较无统计学差异(P0.05),体质指数、骨密度、末次随访ODI评分有明显统计学差异(P0.05);上端固定椎是否在胸腰段(T11~L1)有统计学差异(P0.05),下端固定椎是否在S1及固定节段数无明显统计学差异(P0.05);PJK组术前PJKA(11.25±3.44)明显大于非PJK组(6.74±3.70),两组比较有显著的统计学差异(P0.05);术后及末次随访PJKA两组比较有明显统计学差异(P0.05),两组术前、术后腰椎前凸角(LL)比较无显著统计学差异(P0.05);单因素分析有明显统计学差异的变量行二元logistic回归分析发现骨质疏松、UIV在胸腰段及术前PJk A大于10°是PJK发生的危险因素。结论术前PJKA大于10°,UIV在胸腰段(T11~L1)及骨质疏松是腰椎退行性疾病行后路长节段固定融合术后PJK发生的危险因素。
[Abstract]:Objective proximal junctional kyphosisus (PJK) is a common complication of spinal deformity after orthopedic surgery, which can cause nerve compression in severe cases. Spinal cord damage and other conditions seriously affect the quality of life of patients. At present, there is no clear conclusion on the pathogenesis and risk factors of PJK. The previous studies were mainly about the incidence of PJK in adolescent idiopathic spinal deformities and adult spinal deformities after orthopedic surgery. There was no report on the occurrence of PJK in lumbar degenerative diseases after posterior segmental instrumentation. Based on this status quo, This article intends to follow up the patients with lumbar degenerative diseases treated with posterior long segment fixation fusion and to explore the incidence and risk factors of PJK. Methods A retrospective study of 118 cases of Beijing Army General Hospital from October 2012 to July 2014 was carried out. Patients with lumbar degenerative diseases undergoing posterior long segmental internal fixation fusion in our spinal surgery, Follow up at least 1.5 years. According to inclusion criteria and exclusion criteria, 66 patients with complete data were enrolled and followed up for an average of 3.2 years. Among them, 12 cases had PJK classified as PJK and 54 cases had no PJK classified as non-#en3# group. In order to investigate the risk factors of PJK, We conducted statistical analysis of three types of factors, I. e., general data of patients: gender, age, Body mass index, bone mineral density, BMD2) Surgical factors: upper end fixation of upper instrumentation vertebrae, lower end fixation of lower instrumented vertebrae LIV, number of fixed segments. 3) Imaging parameters: lumbar LLK, proximal end junctional kyphosis angleangle. Assess the severity of the symptoms in both groups, Results among 66 patients, 12 cases developed PJK, 54 cases were classified as PJK group, and 54 cases were classified as non-#en3# group. In this study, the incidence of PJK was 18.18%. There was no significant difference in age, body mass index, bone mineral density. At the last follow-up, there was a significant difference in ODI score (P 0.05), whether the upper end of the fixation vertebra was in the thoracolumbar segment T11L 1 (P 0.05), and whether the lower end of the fixation had no significant difference in the number of S 1 and fixation segments. The preoperative PJKA(11.25 卤3.44 in the P0.05 + PJK group was significantly higher than that in the non-#en2# group. There was significant statistical difference between the two groups (P 0.05), and there was significant difference between the two groups after operation and at the last follow-up (P 0.05). There was no significant difference in LLs between lumbar spine kyphosis and lumbar spine after operation (P 0.05), and binary logistic regression analysis showed that the risk of PJK was found to be higher than 10 掳in thoracolumbar segment and preoperative PJk A of osteoporosis patients with significant statistical difference in univariate analysis. Conclusion preoperative PJKA greater than 10 掳U IV in thoracolumbar segment T11U L1) and osteoporosis are risk factors for PJK after posterior long segment fixation fusion for lumbar degenerative diseases.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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