本文關鍵詞： 腰椎退行性疾病 近端交界性后凸 脊柱后凸　出處：《安徽醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的近端交界性后凸(proximal junctional kyphosis,PJK)是脊柱畸形矯形術后常見的并發(fā)癥,嚴重時能造成神經壓迫、脊髓損害等情況嚴重影響患者的生活質量。目前對PJK的發(fā)病機制及危險因素的研究尚無明確的定論,且以往的研究主要是關于青少年特發(fā)性脊柱畸形及成人脊柱畸形矯形術后PJK發(fā)生的相關報道,尚無文獻對腰椎退行性疾病行后路行長節(jié)段固定融合術后發(fā)生PJK進行報道,基于這一現(xiàn)狀,本文擬對腰椎退行性疾病行后路長節(jié)段固定融合術患者進行隨訪并探討PJK的發(fā)生率及危險因素。方法回顧性研究2012年10月至2014年7月北京陸軍總醫(yī)院收治的118例因腰椎退變性疾病在我院脊柱外科行脊柱后路長節(jié)段內固定融合術的患者,至少隨訪1.5年。根據納入標準和排除標準共入選66例資料完整的患者,平均隨訪3.2年,其中12例發(fā)生PJK歸為PJK組,54例未發(fā)生PJK歸為非PJK組。為了探討PJK的危險因素,我們對三類因素進行了統(tǒng)計分析。(1)病人的一般資料:患者的性別、年齡、體質指數(shù)(body mass index,BMI)、骨密度(bone mineral density,BMD)。(2)外科手術因素:上端固定椎(upper instrumentation vertebrae,UIV)、下端固定椎(lower instrumented vertebra,LIV)、固定節(jié)段數(shù)。(3)影像學參數(shù):腰椎前凸角(lumbar lordosis,LL),近端交界性后凸角(proximal junctional kyphosis angle,PJKA)。為了評估兩組患者癥狀的嚴重程度,我們對術前及末次隨訪ODI進行了統(tǒng)計分析。結果66例患者隨訪中12例發(fā)生PJK,歸為PJK組,54例沒有發(fā)生PJK的患者,歸為非PJK組。在本研究中PJK的發(fā)生率為18.18%。兩組患者性別、年齡比較無統(tǒng)計學差異(P0.05),體質指數(shù)、骨密度、末次隨訪ODI評分有明顯統(tǒng)計學差異(P0.05);上端固定椎是否在胸腰段(T11~L1)有統(tǒng)計學差異(P0.05),下端固定椎是否在S1及固定節(jié)段數(shù)無明顯統(tǒng)計學差異(P0.05);PJK組術前PJKA(11.25±3.44)明顯大于非PJK組(6.74±3.70),兩組比較有顯著的統(tǒng)計學差異(P0.05);術后及末次隨訪PJKA兩組比較有明顯統(tǒng)計學差異(P0.05),兩組術前、術后腰椎前凸角(LL)比較無顯著統(tǒng)計學差異(P0.05);單因素分析有明顯統(tǒng)計學差異的變量行二元logistic回歸分析發(fā)現(xiàn)骨質疏松、UIV在胸腰段及術前PJk A大于10°是PJK發(fā)生的危險因素。結論術前PJKA大于10°,UIV在胸腰段(T11~L1)及骨質疏松是腰椎退行性疾病行后路長節(jié)段固定融合術后PJK發(fā)生的危險因素。
[Abstract]:Objective proximal junctional kyphosisus (PJK) is a common complication of spinal deformity after orthopedic surgery, which can cause nerve compression in severe cases. Spinal cord damage and other conditions seriously affect the quality of life of patients. At present, there is no clear conclusion on the pathogenesis and risk factors of PJK. The previous studies were mainly about the incidence of PJK in adolescent idiopathic spinal deformities and adult spinal deformities after orthopedic surgery. There was no report on the occurrence of PJK in lumbar degenerative diseases after posterior segmental instrumentation. Based on this status quo, This article intends to follow up the patients with lumbar degenerative diseases treated with posterior long segment fixation fusion and to explore the incidence and risk factors of PJK. Methods A retrospective study of 118 cases of Beijing Army General Hospital from October 2012 to July 2014 was carried out. Patients with lumbar degenerative diseases undergoing posterior long segmental internal fixation fusion in our spinal surgery, Follow up at least 1.5 years. According to inclusion criteria and exclusion criteria, 66 patients with complete data were enrolled and followed up for an average of 3.2 years. Among them, 12 cases had PJK classified as PJK and 54 cases had no PJK classified as non-#en3# group. In order to investigate the risk factors of PJK, We conducted statistical analysis of three types of factors, I. e., general data of patients: gender, age, Body mass index, bone mineral density, BMD2) Surgical factors: upper end fixation of upper instrumentation vertebrae, lower end fixation of lower instrumented vertebrae LIV, number of fixed segments. 3) Imaging parameters: lumbar LLK, proximal end junctional kyphosis angleangle. Assess the severity of the symptoms in both groups, Results among 66 patients, 12 cases developed PJK, 54 cases were classified as PJK group, and 54 cases were classified as non-#en3# group. In this study, the incidence of PJK was 18.18%. There was no significant difference in age, body mass index, bone mineral density. At the last follow-up, there was a significant difference in ODI score (P 0.05), whether the upper end of the fixation vertebra was in the thoracolumbar segment T11L 1 (P 0.05), and whether the lower end of the fixation had no significant difference in the number of S 1 and fixation segments. The preoperative PJKA(11.25 鹵3.44 in the P0.05 + PJK group was significantly higher than that in the non-#en2# group. There was significant statistical difference between the two groups (P 0.05), and there was significant difference between the two groups after operation and at the last follow-up (P 0.05). There was no significant difference in LLs between lumbar spine kyphosis and lumbar spine after operation (P 0.05), and binary logistic regression analysis showed that the risk of PJK was found to be higher than 10 擄in thoracolumbar segment and preoperative PJk A of osteoporosis patients with significant statistical difference in univariate analysis. Conclusion preoperative PJKA greater than 10 擄U IV in thoracolumbar segment T11U L1) and osteoporosis are risk factors for PJK after posterior long segment fixation fusion for lumbar degenerative diseases.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R687.3

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本文編號：1547948