Roussouly矢状面改变对术后预后的影响。

IF 3.1 2区 医学 Q2 CLINICAL NEUROLOGY
Oluwatobi O Onafowokan, Pawel P Jankowski, Anthony Yung, Max R Fisher, Nathan Lorentz, Matthew Galetta, Paritash Tahmasebpour, Renaud Lafage, Justin S Smith, Christopher I Shaffrey, Virginie Lafage, Peter G Passias
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引用次数: 0

摘要

目的:本回顾性研究的目的是探讨术后Roussouly矢状面改变与患者预后的关系。方法:从前瞻性收集的单中心数据库中,作者回顾了从基线到术后2年的成人脊柱畸形(ASD)患者的临床和影像学资料。患者按Roussouly曲线类型(当前基于骶骨坡度的类型和“理论”基于骨盆发病率的类型)分层。采用均数比较检验(ANOVA和卡方检验)来评估Roussouly组间的差异。回溯逻辑回归分析用于分析Roussouly矢状面改变与患者预后之间的关系,包括功能指标的最小临床重要差异(MCIDs)。结果:共纳入525例患者,其中79%为女性。队列平均年龄60.8±14.1岁,BMI为27.2±5.5 kg/m2, Charlson合并症指数评分为1.72±1.68。根据Roussouly分类,8.3%的患者为Roussouly 1型(R1)曲线,53.6%为2型(R2)曲线,26.3%为3型(R3)曲线,11.9%为4型(R4)曲线。总体而言,39%的患者术后Roussouly形状改变:59%为R1, 58.5%为R2, 48.1%为R3, 26.7%为R4 (p < 0.001)。48%的患者术后符合理论Roussouly型(R1 41%, R2 41.5%, R3 51.9%, R4 73.3%, p < 0.001)。在控制基线临床和影像学差异的情况下,与近端结膜后凸或近端结膜衰竭高风险相关的Roussouly型变化如下:R1至R2 (or 2.5, 95% CI 1.1-5.6, p = 0.024), R2至R4 (or 2.8, 95% CI 1.1-7.7, p = 0.039), R3至R4 (or 2.3, 95% CI 1.1-4.9, p = 0.033)。R4到R3切换有最高的机械并发症风险(OR 3.4, 95% CI 1.2-9.4, p = 0.016)。R1至R2变化在6周时达到Oswestry残疾指数MCID的比率最高(23.5%,p = 0.004)。Roussouly类型的改变与术后2年脊柱侧凸研究协会(SRS-22r)患者预后问卷(共22项)中MCID的差异无关。结论:虽然很大一部分患者与术后理论Roussouly型匹配,但许多基线匹配的患者在术后容易变得不匹配。术后Roussouly形状改变会影响患者的预后,在计划ASD手术时应考虑到这一点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The impact of Roussouly sagittal profile changes on postoperative outcomes.

Objective: The aim of this retrospective study was to investigate the relationship between postoperative Roussouly sagittal profile changes and patient outcomes.

Methods: From a prospectively collected, single-center database, the authors reviewed the records of patients with adult spinal deformity (ASD) who had clinical and radiographic data from baseline to 2 years after surgery. The patients were stratified by their Roussouly curve type (current sacral slope-based and "theoretical" pelvic incidence-based types). Means comparison tests (ANOVA and chi-square) were used to assess differences among Roussouly groups. Backstep logistic regression analyses were used to analyze associations between Roussouly sagittal profile changes and patient outcomes, including minimum clinically important differences (MCIDs) in functional metrics.

Results: Five hundred twenty-five patients, 79% of whom were female, were included in this study. The mean age of the cohort was 60.8 ± 14.1 years, BMI was 27.2 ± 5.5 kg/m2, and Charlson Comorbidity Index score was 1.72 ± 1.68. According to the Roussouly classification, 8.3% of patients had a Roussouly type 1 (R1) curve, 53.6% type 2 (R2), 26.3% type 3 (R3), and 11.9% type 4 (R4). Overall, 39% of patients had a changed Roussouly shape postoperatively: 59% had R1, 58.5% R2, 48.1% R3, and 26.7% R4 (p < 0.001). Forty-eight percent of patients matched the theoretical Roussouly type postoperatively (41% R1, 41.5% R2, 51.9% R3, and 73.3% R4, p < 0.001). When controlling for baseline clinical and radiographic differences, the Roussouly type changes associated with a higher risk of proximal junctional kyphosis or proximal junctional failure were as follows: R1 to R2 (OR 2.5, 95% CI 1.1-5.6, p = 0.024), R2 to R4 (OR 2.8, 95% CI 1.1-7.7, p = 0.039), and R3 to R4 (OR 2.3, 95% CI 1.1-4.9, p = 0.033). R4 to R3 switches had the highest mechanical complication risks (OR 3.4, 95% CI 1.2-9.4, p = 0.016). R1 to R2 changes had the highest rate of attaining an MCID in the Oswestry Disability Index at 6 weeks (23.5%, p = 0.004). Roussouly type changes were not associated with differences in the MCID on the refined 22-item Scoliosis Research Society patient outcome questionnaire (SRS-22r) up to 2 years after surgery.

Conclusions: While a significant portion of patients matched their postoperative theoretical Roussouly type, many of those matched at baseline were prone to become unmatched postoperatively. Postoperative Roussouly shape changes influence patient outcomes and should be accounted for when planning ASD surgery.

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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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