利用术前俯卧位和仰卧位x线片骨盆发生率预测成人脊柱畸形胸腰椎融合术后骨盆发生率。

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY
Zach Pennington, Michael L Martini, Anthony L Mikula, Maria Astudillo Potes, Abdelrahman M Hamouda, Nikita Lakomkin, Arjun Sebastian, Brett A Freedman, Ahmad N Nassr, Jeremy L Fogelson, Benjamin D Elder
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引用次数: 0

摘要

目的:骨盆发生率(PI)是矢状位对准的关键参数。虽然传统上认为PI是固定的,但越来越多的证据表明PI可能是可变的。本研究旨在确定PI随患者体位变化的预测因素,并评估术前影像学特征和术中操作与术后PI的关系。方法:对接受胸腰骶融合的患者进行识别,收集术前脊柱骨盆参数、患者人口学特征和手术细节的数据。术前通过直立、仰卧和俯卧位x线片测量脊柱骨盆参数。对不同体位患者的PI进行单变量比较。对术后6周x线片进行多变量分析,以确定与PI独立相关的变量。PI的变化定义为位置之间的变化≥5°。结果:共发现138例患者(平均±SD年龄66.0±8.7岁;38.4%的男性)。术前仰卧位与站立位(平均-3.2°±4.2°,p < 0.001)、术前仰卧位与俯卧位(3.5°±4.7°,p < 0.001)、术前和术后6周站立位(1.5°±6.2°,p = 0.01)、即刻和6周直立位(1.1°±3.9°,p = 0.007) x线片PI差异有统计学意义。单变量比较显示,从站立到仰卧的PI下降仅与体重有关(87.0±15.0 vs 81.1±19.3 kg, p = 0.04);从站立到俯卧没有显著的PI增加的预测因子。术前PI等级较低(p < 0.001)、L5/S1椎间放置(74.4% vs 52.0%, p = 0.02)、术前站立至仰卧(12.8% vs 39.8%, p = 0.002)和站立至俯卧(51.3% vs 13.3%, p < 0.001)均可预测术前至6周站立x线片PI升高。多变量分析显示,术后6周PI仅与术前仰卧位PI (B = 0.293, 95% CI 0.10-0.48, p = 0.003)和俯卧位PI (B = 0.647, 95% CI 0.44-0.85, p < 0.001)相关。结论:在没有骨盆固定的患者中,PI存在体位依赖性改变。即使在双侧单个s2 -侧髂螺钉骨盆固定后,PI也有统计学上的显著变化。术前仰卧位和俯卧位x线片上的PI比直立x线片上的PI更能预测术后PI,这表明术前俯卧位和仰卧位x线片可以为外科医生提供最佳信息,以实现PI-腰椎前凸不匹配< 10°。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of pelvic incidence on preoperative prone and supine radiography to predict postoperative pelvic incidence following thoracolumbar fusion for adult spinal deformity.

Objective: Pelvic incidence (PI) is a key parameter of sagittal alignment. While conventionally held to be fixed, increasing evidence suggests PI may be variable. This study aimed to identify predictors of change in PI with patient position and to assess the association of preoperative radiographic characteristics and intraoperative maneuvers with postoperative PI.

Methods: Patients who underwent thoracolumbosacral fusion were identified, and data were gathered on preoperative spinopelvic parameters, patient demographic characteristics, and operative details. Preoperative spinopelvic parameters were measured on upright, supine, and prone radiographs. Univariable comparisons of PI between the different patient positions were performed. Multivariable analysis was performed to identify variables independently correlated with PI on 6-week postoperative radiographs. Change in PI was defined as ≥ 5° change between positions.

Results: In total, 138 patients were identified (mean ± SD age 66.0 ± 8.7 years; 38.4% male). Statistically significant differences in PI were noted between preoperative standing and supine (mean -3.2° ± 4.2°, p < 0.001), preoperative supine and prone (3.5° ± 4.7°, p < 0.001), preoperative and 6-week postoperative standing (1.5° ± 6.2°, p = 0.01), and immediate and 6-week upright (1.1° ± 3.9°, p = 0.007) radiographs. Univariable comparisons showed PI decrease from standing to supine was predicted only by weight (87.0 ± 15.0 vs 81.1 ± 19.3 kg, p = 0.04); there were no significant predictors of increase in PI from standing to prone. Increase in PI from preoperative to 6-week standing radiographs was predicted by lower preoperative PI class (p < 0.001), L5/S1 interbody placement (74.4% vs 52.0%, p = 0.02), and change in PI from preoperative standing to supine (12.8% vs 39.8%, p = 0.002) and from standing to prone (51.3% vs 13.3%, p < 0.001). Multivariable analysis showed that 6-week postoperative PI was associated with only preoperative supine PI (B = 0.293, 95% CI 0.10-0.48, p = 0.003) and prone PI (B = 0.647, 95% CI 0.44-0.85, p < 0.001).

Conclusions: There are position-dependent changes in PI among patients without prior pelvic fixation. Statistically significant changes in PI are seen even after pelvic fixation with a single S2-alar-iliac screw bilaterally. Postoperative PI was best predicted by preoperative PI on supine and prone radiographs rather than upright radiographs, suggesting that preoperative prone and supine radiographs may provide surgeons with the best information for achieving PI-lumbar lordosis mismatch < 10°.

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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
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