摘要
目的:探讨经皮椎体后凸成形(PKP)术后脊柱-骨盆动态姿势与矢状面平衡参数联合预测相邻椎体继发骨折的价值.方法:选取2021 年 1 月至 2022 年 6 月 106 例骨质疏松性胸椎压缩骨折(OVCF)患者,均接受PKP 手术治疗,术后 3 个月测量脊柱-骨盆的动态姿势参数(静态时脊柱旋转幅度、行走时脊柱侧倾幅度、前倾幅度)、矢状面平衡参数[脊柱矢状轴(SVA)、骶骨倾斜角(SS)、胸椎后凸角(TK)、骨盆入射角(PI)、腰椎前凸角(LL)、骨盆倾斜角(PT)、T1 骨盆角(TPA)],随访1 年,根据相邻椎体是否继发骨折分为继发组(37 例)与未继发组(69 例).比较两组脊柱-骨盆的动态姿势、矢状面平衡参数,分析脊柱-骨盆的动态姿势与矢状面平衡参数相关性及预测价值.结果:继发组脊柱旋转幅度小于未继发组,侧倾幅度、前倾幅度大于未继发组(P<0.05);继发组SVA、TK大于未继发组,LL、SS、PI小于未继发组(P<0.05);脊柱旋转幅度与SVA、TK呈负相关,与LL、SS、PI呈正相关,侧倾幅度、前倾幅度与SVA、TK呈正相关,与 LL、SS、PI 呈负相关(P<0.05);脊柱侧倾幅度、前倾幅度、SVA、TK 高值、脊柱旋转幅度、LL、SS、PI低值会显著增加相邻椎体继发骨折风险(P<0.05);脊柱-骨盆动态姿势参数联合矢状面平衡参数预测相邻椎体继发骨折的AUC为0.920(95%CI:0.851～0.964),敏感度为 89.19%,特异度为82.61%,优于脊柱-骨盆动态姿势参数联合预测、矢状面平衡参数联合预测及各参数单独预测.结论:OVCF患者PKP 术后脊柱-骨盆动态姿势与矢状面平衡参数显著相关,均会增加相邻椎体继发骨折风险,联合预测价值可靠.
Abstract
Objective:To investigate the value of combining postoperative spine-pelvis dynamic posture and sagittal balance parameters in predicting adjacent vertebral fractures following percutaneous kyphoplasty(PKP).Methods:A total of 106 patients with osteoporotic vertebral compression fracture(OVCF)from Jan-uary 2021 to June 2022 were selected,all of whom received PKP surgery.Dynamic spindle-pelvis postural parameters(spine rotation amplitude at rest,scoliosis amplitude during walking,and forward inclination am-plitude),sagittal plane balance parameters[Sagittal axis(SVA),sacral inclination Angle(SS),thoracic kyphosis Angle(TK),pelvic incidence Angle(PI),lumbar lordosis Angle(LL),pelvic inclination Angle(PT),and T1 pelvic Angle(TPA)]were measured 3 months after surgery.Patients were followed up for one year and divided into the fracture group(37 cases)and non-fracture group(69 cases)based on the occur-rence of adjacent vertebral fractures.The dynamic posture and sagittal plane balance parameters of the spine and pelvis were compared between the two groups,and the correlation and predictive value of the dynamic posture and sagittal plane balance parameters were analyzed.Results:The rotation amplitude of the fracture group was smaller,while lateral and forward inclination amplitudes were larger than those of the non-fracture group(P<0.05).SVA and TK were greater in the fracture group,while LL,SS,and PI were smaller com-pared to the non-fracture group(P<0.05).Rotation amplitude showed a negative correlation with SVA and TK,and a positive correlation with LL,SS,and PI.Lateral and forward inclination amplitudes were positively correlated with SVA and TK,and negatively correlated with LL,SS,and PI(P<0.05).High values of later-al and forward inclination,SVA,TK,and low values of rotation amplitude,LL,SS,PI significantly in-creased the risk of adjacent vertebral fractures(P<0.05).The combined prediction of spine-pelvis dynamic posture parameters and sagittal balance parameters for adjacent vertebral fractures had an AUC of 0.920(95%CI:0.851-0.964),sensitivity of 89.19%,and specificity of 82.61%,outperforming predictions based solely on dynamic posture or sagittal balance parameters.Conclusion:Postoperative spine-pelvis dynamic posture and sagittal balance parameters are significantly correlated in OVCF patients undergoing PKP and are associated with an increased risk of adjacent vertebral fractures.The combined prediction of these parameters provides a reliable and superior method for predicting such fractures.
基金项目
河北省医学科学研究项目(2022)(20221698)
维普
万方数据