脊柱畸形矫形术后近端交界性后凸和交界性失败的研究进展

发布时间：2019-03-30 22:11

【摘要】：脊柱畸形患者临床中并不少见,脊柱的后凸或侧凸畸形不但导致躯体矢状位、冠状位失平衡,同时由于腰椎代偿性过度前凸,从而引发患者顽固性腰背部疼痛,与此同时,还可以造成患者严重的心理负担以及工作和生活上的不便。此外,严重的后凸畸形还可影响患者心肺功能,并可引起脊髓功能损害。因此,矫正脊柱畸形不仅改善患者畸形外观,更重要的是对于改善患者心肺功能障碍和缓解神经损害起着至关重要的预防和治疗作用。随着内固定技术以及各种截骨手术方式的发展,不同类型的脊柱畸形得以通过长节段截骨、固定、融合脊柱矫形手术解除脊柱畸形的神经症状及矢状位、冠状位的失平衡,从而改善患者的生活质量。然而,术后的临近节段病变的发生对于术后患者症状的恢复、矫形角度的维持始终存在威胁。在众多脊柱矫形术后发生的并发症中,近端交界性后凸和近端交界性失败可能造成脊柱矢状面失平衡的加剧或出现严重的神经损害,并且部分患者需要手术干预才能解决其症状,因此受到广泛关注。由于PJK和PJF的描述与概念提出时间较短,在多种脊柱术后并发症中其发生发展机制尚未完全了解。通过本次对文献的系统性回顾,发现脊柱矫形术后发生PJK的危险因素有:年龄大于55岁;术前患者严重矢状面失平衡;前后路联合内固定手术;长节段融合至下腰椎或骶骨;胸廓成形术;采用刚性较强的椎弓根螺钉内固定系统;肥胖(BMI30)以及骨质疏松。发生机制为:内固定节段上方广泛椎旁肌的损伤;棘上韧带和棘间韧带(后张力带)的破坏;端椎选择不当;近端椎间盘严重退变;近端椎体压缩性骨折;近端椎体内固的失败;小关节损伤。因此,通过对术后PJK的发生、发展的危险因素和产生机制的研究,有助于临床医生在手术前、手术中和手术后减少或避免上述危险因素,从而明显减少脊柱畸形术后PJK的发生率,更好的减轻病人症状,提高病人生活质量。
[Abstract]:The kyphosis or scoliosis of the spine not only leads to sagittal and coronal imbalance of the body, but also leads to intractable lumbar back pain due to compensatory hyperkyphosis of the lumbar vertebra. It can also cause serious psychological burden and inconvenience to work and life. In addition, severe kyphosis can affect cardio-pulmonary function and cause spinal cord dysfunction. Therefore, the correction of spinal malformations not only improves the appearance of malformations, but also plays an important role in prevention and treatment of cardio-pulmonary dysfunction and nerve damage. With the development of internal fixation technology and various osteotomy methods, different types of spinal malformations can be removed from neurological symptoms and sagittal and coronal imbalance by long segment osteotomy, fixation, and spinal fusion orthopedic surgery. In order to improve the quality of life of patients. However, the occurrence of postoperative adjacent segmental lesions is always a threat to the recovery of symptoms and the maintenance of orthopaedic angle. Among the complications of spinal correction surgery, proximal junction kyphosis and proximal junction failure may result in aggravation of spinal sagittal imbalance or severe neurological damage. And some patients need surgical intervention to solve their symptoms, so it has received extensive attention. Because the description and concept of PJK and PJF have been put forward for a short time, the mechanism of occurrence and development of various postoperative complications of spine has not been fully understood. Through a systematic review of the literature, it was found that the risk factors of PJK after spinal correction included age over 55 years, severe sagittal plane imbalance before and after operation, anterior and posterior combined internal fixation, long segment fusion to lower lumbar vertebrae or sacrum, and severe sagittal plane imbalance before and after operation, and long segment fusion to lower lumbar vertebrae or sacrum. Thoracoplasty; rigid pedicle screw fixation system; obesity (BMI30) and osteoporosis. The mechanism is: injury of extensive paravertebral muscle above internal fixation segment; destruction of supraspinal ligament and interspinous ligament (posterior tension band); inappropriate choice of end vertebra; severe degeneration of proximal intervertebral disc; compression fracture of proximal vertebral body; Failure of internal fixation of the proximal vertebral body; facet joint injury. Therefore, it is helpful for clinicians to reduce or avoid the above-mentioned risk factors before, during and after the operation by studying the risk factors and mechanism of the development of postoperative PJK. Thus, the incidence of PJK after spinal malformations was significantly reduced, the symptoms of patients were alleviated, and the quality of life of the patients was improved.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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