袁 磊,陈萧霖,曾 岩,陈仲强,齐 强,郭昭庆,李危石,孙垂国,张心灵,买 硕.退变性腰椎侧凸患者椎旁肌退变与术后近端交界性后凸的相关性研究[J].中国脊柱脊髓杂志,2018,(5):425-433.
退变性腰椎侧凸患者椎旁肌退变与术后近端交界性后凸的相关性研究
中文关键词:  退变性腰椎侧凸  椎旁肌退变  近端交界性后凸
中文摘要:
  【摘要】 目的:探讨退变性腰椎侧凸(degenerative lumbar scoliosis,DLS)患者术前腰椎椎旁肌肉的退变程度与后路长节段固定融合术后近端交界性后凸(proximal junctional kyphosis,PJK)发生的关系。方法:本研究共纳入52例DLS患者,根据末次随访是否发生PJK分为PJK组(10例)及无PJK(non-PJK)组(42例)。影像学评估包括脊柱骨盆矢状位参数、腰椎椎旁肌肌量(肌肉与椎体/椎间盘横截面积比值)以及肌肉-脂肪指数(肌肉与皮下脂肪的平均信号强度之比)。利用Logistic回归分析PJK发生的危险因素。比较两组患者一般资料、术前及随访时腰痛VAS及健康相关生活质量评分(SRS-22)。结果:本组患者PJK发生率为19.23%。患者手术年龄、性别、身体质量指数、患病时长、糖尿病、截骨及椎间融合、固定节段数、减压节段数、骨密度T值在PJK组及无PJK组均未见明显统计学差异。术前骨矿盐密度(bone mineral density,BMD)较低、术前胸腰段后凸角(TLK)较大、术中胸椎后凸角(TK)矫正过大、最上端固定椎(UIV)位于T12-L1、术后即刻交界性后凸角(PJA)过大、术前骶骨倾斜角(SS)较小、术后PJA变化值较大、腰背伸肌群脂肪退变明显可能与腰椎退变性侧凸长节段固定术后发生PJK相关。通过Logistic回归分析发现,术前SS<25°(OR=12.902,P=0.046)、术后即刻PJA增大≥3.6°(OR=21.940,P=0.015)、腰背伸肌肌肉-脂肪指数≥27.65(OR=11.749,P=0.019)为发生PJK的独立危险因素。PJK患者的随访腰痛VAS及SRS-22功能状态评分较non-PJK组差。结论:DLS术后发生PJK患者,术前腰椎椎旁肌肌量较低、脂肪退变明显。术前SS<25°、术后即刻PJA增大≥3.6°、腰背伸肌肌肉-脂肪指数≥27.65为发生PJK的独立危险因素。
The association between the degeneration of the paraspinal muscles in patients with degenerative lumbar scoliosis and the postoperative proximal junctional kyphosis(PJK)
英文关键词:Degenerative lumbar scoliosis  Degeneration of the paraspinal muscles  Proximal junctional kyphosis
英文摘要:
  【Abstract】 Objectives: To investigate the relationship between the degeneration of preoperative lumbar paravertebral muscles and the incidence of proximal junctional kyphosis(PJK) in degenerative lumbar scoliosis(DLS) patients after posterior long instrumented spinal fusion. Methods: Fifty-two patients diagnosed with DLS were included. According to the occurrence of PJK at final follow-up, patients were divided into two groups: PJK group(10 cases) and non-PJK group(42 cases). Radiographic assessment included pelvic parameters, lumbar muscularity(the ratio between the cross-sectional area of the muscle and the intervertebral disk/vertebral body) and the muscle-fat index(the ratio between the mean signal intensity of the muscle and that of the subcutaneous fat within regions of interest. Logistic regression analysis was used to explore the risk factors of PJK. Preoperative and follow-up health related quality of life scores were compared between PJK group and non-PJK group. Results: The prevalence of PJK was 19.23%. Age at surgery, gender, BMI, duration of disease, diabetes mellitus, osteotomy, fused levels, fixation levels, decompression levels, UIV level, LIV level and T-score were not significantly different between PJK and non-PJK group. Preoperative lower bone mineral density(BMD), preoperative smaller SS, larger preoperative TLK angle, larger TK correction and changes of proximal junctional angle(PJA) during operation, UIV at T12-L1, larger PJA immediately after surgery, and lower lumbar muscularity and higher fatty degeneration might lead to PJK after long instrumented spinal fusion for degenerative lumbar scoliosis. Patients with PJK had worse back pain VAS score and SRS-22 activity score. When included in a multivariate logistic regression model, preoperative SS<25°(OR=12.902, P=0.046), immediate postoperative PJA increase ≥3.6°(OR=21.940, P=0.015) and lean muscle-fat index of paraspinal extensor muscle >27.65(OR=11.749, P=0.019) were independent risk factors for PJK. Conclusions: DLS patients with PJK have lower lumbar muscularity and higher fatty degeneration before surgery than patients without PJK. Preoperative SS<25°, immediate postoperative PJA increase ≥3.6° and lean muscle-fat index of paraspinal extensor muscle >27.65 are independent risk factors for PJK.
投稿时间:2018-01-14  修订日期:2018-04-12
DOI:
基金项目:2016年北京市自然科学基金资助项目(编号:7162198)
作者单位
袁 磊 北京大学第三医院骨科 100191 北京市 
陈萧霖 重庆医科大学附属第二医院骨科 400010 重庆市 
曾 岩 北京大学第三医院骨科 100191 北京市 
陈仲强  
齐 强  
郭昭庆  
李危石  
孙垂国  
张心灵  
买 硕  
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