成人脊柱畸形的长节段融合手术和前柱矫正术后近端连接并发症和杆骨折的发生率和风险因素:至少两年的随访。

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Dong-Ho Kang, Jin-Sung Park, Se-Jun Park, Chong-Suh Lee
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引用次数: 0

摘要

背景和目的研究因成人脊柱畸形而接受长节段(≥4级)融合手术并行前柱复位(ACR)的患者中,近端交界性脊柱后凸(PJK)、近端交界失败(PJF)和骨棒骨折的发生率和风险因素:根据 PJK、PJF 和杆骨折发生情况对年龄≥60 岁、随访至少 2 年的患者进行分组。比较患者、手术和放射学因素,以确定这些并发症的风险因素。通过单变量和多变量逻辑回归确定了独立的风险因素:在106名患者中,PJK、PJF和杆骨折的发生率分别为15.1%、28.3%和17.9%。PJK与较少的融合层次(几率比[95% CI],0.30 [0.13-0.69])、颅向最上器械椎体(UIV)螺钉角度(1.40 [1.13-1.72])、术后过度矫正年龄调整后的骨盆入射角-腰椎前凸(LL)(7.22 [1.13-45.93])以及胸椎后凸的大幅增加(1.09 [1.01-1.17])。PJF风险与头颅UIV螺钉方向(1.23 [1.09-1.39])、年龄调整后骨盆内陷-LL过度矫正(10.80 [2.55-45.73])和骶骨斜度变化较小(0.87 [0.80-0.94])有关。对于棒状骨折,突出的因素包括融合层次较多(1.70 [1.17-2.46])、术后LL较大(1.07 [1.01-1.15])、术后胸椎后凸较小(0.92 [0.86-0.98])、骶骨斜度(0.73 [0.58-0.92])和骨盆倾斜(0.72 [0.56-0.91])变化较小:结论:PJK、PJF和杆骨折的发生率和风险因素与之前关于无ACR长节段融合手术的研究中观察到的相似。ACR水平的数量并不是PJK、PJF或杆骨折的重要风险因素。在使用 ACR 进行畸形矫正时,外科医生应仔细考虑 UIV 螺钉的方向,并确保避免过度矫正。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Incidence and Risk Factors of Proximal Junctional Complications and Rod Fractures After Long-Segment Fusion Surgery With Anterior Column Realignment for Adult Spinal Deformity: A Minimum 2-Year Follow-Up.

Background and objectives: To investigate the incidence and risk factors of proximal junctional kyphosis (PJK), proximal junctional failure (PJF), and rod fractures in patients undergoing long-segment (≥4 levels) fusion surgery with anterior column realignment (ACR) for adult spinal deformity.

Methods: Patients aged ≥60 years with at least a 2-year follow-up were grouped based on PJK, PJF, and rod fracture occurrence. Patient, surgical, and radiographic factors were compared to identify risk factors for these complications. Independent risk factors were identified using univariate and multivariate logistic regression.

Results: Among 106 patients, the incidence rates of PJK, PJF, and rod fractures were 15.1%, 28.3%, and 17.9%, respectively. PJK was significantly associated with fewer fusion levels (odds ratio [95% CI], 0.30 [0.13-0.69]), a cranially directed uppermost instrumented vertebra (UIV) screw angle (1.40 [1.13-1.72]), postoperative overcorrection of age-adjusted pelvic incidence-lumbar lordosis (LL) (7.22 [1.13-45.93]), and a large increase in thoracic kyphosis (1.09 [1.01-1.17]). PJF risks were associated with a cranial UIV screw orientation (1.23 [1.09-1.39]), overcorrection of age-adjusted pelvic incidence-LL (10.80 [2.55-45.73]), and a smaller change in sacral slope (0.87 [0.80-0.94]). For rod fractures, prominent factors included a greater number of fusion levels (1.70 [1.17-2.46]), a larger postoperative LL (1.07 [1.01-1.15]), a smaller postoperative thoracic kyphosis (0.92 [0.86-0.98]), and smaller changes in sacral slope (0.73 [0.58-0.92]) and pelvic tilt (0.72 [0.56-0.91]).

Conclusion: The incidence and risk factors of PJK, PJF, and rod fractures were similar to those observed in previous studies on long-segment fusion surgery without ACR. The number of ACR levels was not a significant risk factor for PJK, PJF, or rod fractures. When performing deformity correction using ACR, surgeons should carefully consider the direction of the UIV screw and ensure that overcorrection is avoided.

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来源期刊
Neurosurgery
Neurosurgery 医学-临床神经学
CiteScore
8.20
自引率
6.20%
发文量
898
审稿时长
2-4 weeks
期刊介绍: Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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