重度僵硬性脊柱侧凸术后远端叠加现象的危险因素分析
发布时间：2018-07-14 18:55
【摘要】：目的:研究重度僵硬性脊柱侧凸术后远端叠加现象的相关危险因素及其影响。方法:2008年1月至2013年12月,回顾性分析我院行单纯后路螺钉内固定矫形术的重度僵硬性脊柱侧凸患者的术前、术后、随访≥2年的影像学资料和临床资料。根据随访结果将患者分为远端叠加现象阳性组和阴性组,使用单因素方差分析或卡方检验对两组患者的多个危险因素进行对比分析,得出有统计学差异的相关危险因素,然后用logistic回归分析方法检出重度僵硬性脊柱侧凸术后远端叠加现象的独立危险因素。结果:符合纳入标准且获得完整随访资料的患者共48例。所有患者均随访24月及以上,平均随访时间34.7(24~52)月。患者的平均主胸弯Cobb角和主胸弯柔韧性分别为107.4°±15.9°、16.4%±10.2%。随访结果显示其中12(25%)例患者出现术后远端叠加现象。患者的年龄、Risser征、主胸弯柔韧度与术后远端叠加现象的相关性有统计学意义;患者术后资料中与远端叠加现象的相关性有统计学意义的危险因素有:术后主胸弯Cobb角、主胸弯矫正率、腰弯矫正率、融合节段长度、主胸弯顶椎偏移度、术后下端固定椎倾斜角,下端固定椎与下端椎、稳定椎、偏移椎、最后触及椎、最后实质触及椎之间的椎体节段差;患者随访资料中与远端叠加现象的相关性有统计学意义的危险因素有:随访主胸弯Cobb角、主胸弯矫正率、主胸弯顶椎偏移距离、下端固定椎倾斜角;另外,术后主胸弯顶椎偏移度较术前变化值、术后下端固定椎到骶正中线距离较术前变化值、随访下端固定椎到骶正中线距离较术后变化值与术后远端叠加现象的相关性有统计学意义。logistic回归分析显示主胸弯矫正率(OR:1.107,95%CI:1.024—1.197,P=0.011)和下端固定椎与最后触及椎椎体节段差(OR:0.121,95%CI:0.028—0.518,P=0.004)是重度僵硬性脊柱侧凸术后远端叠加现象的两个独立危险因素。结论:较高的主胸弯矫正率和下端固定椎选择高于最后触及椎与重度僵硬性脊柱侧凸术后远端叠加现象的发生密切相关。
[Abstract]:Objective: to study the risk factors and influence of distal superposition after severe stiff scoliosis. Methods: from January 2008 to December 2013, the preoperative and postoperative imaging data and clinical data of patients with severe rigid scoliosis undergoing simple posterior screw fixation were retrospectively analyzed. According to the follow-up results, the patients were divided into two groups: positive group and negative group. Univariate ANOVA or chi-square test were used to compare and analyze the risk factors of the two groups. Then logistic regression analysis was used to detect the independent risk factors of distal superposition after severe stiff scoliosis. Results: a total of 48 patients met the inclusion criteria and obtained complete follow-up data. All patients were followed up for 24 months or more, with an average follow-up time of 34.7 (24 / 52) months. The mean Cobb angle and flexibility of the main thoracic curvature were 107.4 掳卤15.9 掳and 16.4% 卤10.2%, respectively. Follow-up results showed that 12 (25%) of the patients had postoperative distal superposition. Risser's sign, flexibility of main thoracic bending and distal superposition were significantly correlated with the postoperative data, and the risk factors of the correlation were: Cobb angle of the main thoracic curvature after operation, and the correlation between the data of the patients and the distal superposition of the patients after the operation, and the risk factors of the patients were as follows: the cob angle of the main thoracic curvature after operation. The correction rate of the main thoracic curvature, the correction rate of the lumbar curve, the length of the fusion segment, the deviation degree of the main thoracic curved top vertebra, the fixation of the inclination angle of the lower end of the vertebra, the fixation of the lower end of the vertebra and the lower end of the vertebra, the stabilization of the vertebra, the deviation of the vertebrae, and finally The risk factors associated with distal superposition in the follow-up data were: Cobb angle of the main thoracic curvature, correction rate of the main thoracic curvature, deviation distance of the top vertebra of the main thoracic curvature. The angle of inclination was fixed at the lower end of the vertebra, in addition, the deviation of the main thoracic curvature was higher than that of the preoperative, and the distance from the lower end of the fixation to the median sacral line was higher than that before the operation. Logistic regression analysis showed that the correction rate of principal thoracic curvature (OR: 1.107 ~ 95CI: 1.024-1.197 P0.011) and the fixation of the lower end of the vertebra and the final touch of vertebral body segment were significantly higher than those of the postoperatively fixed vertebrae and the distal superposition of the distal end of the vertebrae (OR: 1.107 ~ 95CI: 1.024-1.197 P0.011). The segmental difference (OR: 0.121 / 95) is two independent risk factors for the distal superposition after severe stiff scoliosis (CI: 0.028-0.518 P0.004). Conclusion: the higher correction rate of main thoracic curvature and the choice of lower end fixation are higher than those of the last touch vertebrae and the distal superposition of severe stiff scoliosis.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
本文编号：2122638
[Abstract]:Objective: to study the risk factors and influence of distal superposition after severe stiff scoliosis. Methods: from January 2008 to December 2013, the preoperative and postoperative imaging data and clinical data of patients with severe rigid scoliosis undergoing simple posterior screw fixation were retrospectively analyzed. According to the follow-up results, the patients were divided into two groups: positive group and negative group. Univariate ANOVA or chi-square test were used to compare and analyze the risk factors of the two groups. Then logistic regression analysis was used to detect the independent risk factors of distal superposition after severe stiff scoliosis. Results: a total of 48 patients met the inclusion criteria and obtained complete follow-up data. All patients were followed up for 24 months or more, with an average follow-up time of 34.7 (24 / 52) months. The mean Cobb angle and flexibility of the main thoracic curvature were 107.4 掳卤15.9 掳and 16.4% 卤10.2%, respectively. Follow-up results showed that 12 (25%) of the patients had postoperative distal superposition. Risser's sign, flexibility of main thoracic bending and distal superposition were significantly correlated with the postoperative data, and the risk factors of the correlation were: Cobb angle of the main thoracic curvature after operation, and the correlation between the data of the patients and the distal superposition of the patients after the operation, and the risk factors of the patients were as follows: the cob angle of the main thoracic curvature after operation. The correction rate of the main thoracic curvature, the correction rate of the lumbar curve, the length of the fusion segment, the deviation degree of the main thoracic curved top vertebra, the fixation of the inclination angle of the lower end of the vertebra, the fixation of the lower end of the vertebra and the lower end of the vertebra, the stabilization of the vertebra, the deviation of the vertebrae, and finally The risk factors associated with distal superposition in the follow-up data were: Cobb angle of the main thoracic curvature, correction rate of the main thoracic curvature, deviation distance of the top vertebra of the main thoracic curvature. The angle of inclination was fixed at the lower end of the vertebra, in addition, the deviation of the main thoracic curvature was higher than that of the preoperative, and the distance from the lower end of the fixation to the median sacral line was higher than that before the operation. Logistic regression analysis showed that the correction rate of principal thoracic curvature (OR: 1.107 ~ 95CI: 1.024-1.197 P0.011) and the fixation of the lower end of the vertebra and the final touch of vertebral body segment were significantly higher than those of the postoperatively fixed vertebrae and the distal superposition of the distal end of the vertebrae (OR: 1.107 ~ 95CI: 1.024-1.197 P0.011). The segmental difference (OR: 0.121 / 95) is two independent risk factors for the distal superposition after severe stiff scoliosis (CI: 0.028-0.518 P0.004). Conclusion: the higher correction rate of main thoracic curvature and the choice of lower end fixation are higher than those of the last touch vertebrae and the distal superposition of severe stiff scoliosis.
【学位授予单位】：首都医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
【参考文献】
相关期刊论文 前1条
1 ;Posterior Selective Thoracic Fusion in Adolescent Idiopathic Scoliosis Patients:a Comparison of All Pedicle Screws versus Hybrid Instrumentation[J];Chinese Medical Sciences Journal;2009年01期
，本文编号：2122638
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