经骶2骶髂螺钉固定的退行性脊柱畸形患者上端固定椎HU值对术后近端交界性后凸的预测价值
Prediction value of hounsfield units at upper instrumented vertebra for postoperative proximal junctional kyphosis af-ter pelvic fixation with second sacralalar-iliac in patients with degenerative spinal deformity
孙幸 1李劼 2许彦劼 2胡宗杉 2汤子洋 1徐辉 2刘臻 3邱勇 3朱泽章3
作者信息
- 1. 南京医科大学鼓楼临床医学院骨科脊柱外科,南京 210008
- 2. 南京大学医学院附属鼓楼医院骨科脊柱外科,南京 210008
- 3. 南京医科大学鼓楼临床医学院骨科脊柱外科,南京 210008;南京大学医学院附属鼓楼医院骨科脊柱外科,南京 210008
- 折叠
摘要
目的 探讨经骶2骶骼(second sacralalar-iliac,S2AI)螺钉固定的退行性脊柱畸形患者上端固定椎(upper in-strumented vertebra,UIV)HU值对术后近端交界性后凸(proximal junctional kyphosis,PJK)的预测价值.方法 回顾性分析2015年8月至2021年4月在南京鼓楼医院接受S2AI螺钉固定技术进行骨盆固定的66例退行性脊柱畸形患者的病历资料,男4例、女62例,年龄(61.9±7.3)岁(范围43～78岁),随访时间为(18.4±14.3)个月(范围6～60个月).术后随访期间PJK发生率为26％(17/66),根据是否发生PJK将患者分为PJK组(17例)及非PJK组(49例).在术前CT上测量UIV及其上位椎体(UIV+1)以及L3和L4椎体的HU值.术前、术后及末次随访时测量以下影像学参数:胸椎后凸角(thoracic kyphosis,TK)、腰椎前凸角(lumbar lordosis,LL)、骶骨倾斜角(sacral slope,SS)、骨盆倾斜角(pelvic tilt,PT)、骨盆入射角(pelvic incidence,PI)、PI 与 LL匹配程度(the mismatch between pelvic incidence and lumbar lordosis,PI-LL)、矢状面平衡(sagittal vertical axis,SVA).比较两组患者的一般资料及HU值,对L3和L4平均HU值与骨密度及骨密度T值行Pearson相关性分析,应用logis-tics回归分析PJK发生的危险因素.结果 两组患者的年龄、性别、随访时间、固定节段数量、骨密度及其T值、L3和L4平均HU值的差异均无统计学意义(P＞0.05).PJK组UIV和UIV+1平均HU值为104.3±32.9,而非PJK组为133.7±29.5,差异有统计学意义(t=3.441,P=0.001).L3和L4平均HU值与骨密度及骨密度T值呈正相关(r=0.530,P＜0.001;r=0.537,P＜0.001).PJK组与非PJK组患者的术后TK、术前LL、LL矫正值,术前PI-LL和PI-LL改变值的差异均有统计学意义.Lo-gistic 回归分析显示,UIV 和 UIV+1 平均 HU 值[OR=0.960,95％C1(0.933,0.987),P=0.004]、LL矫正值[OR=1.049,95％CI(1.007,1.092),P=0.023]是PJK的独立危险因素.通过ROC曲线确定UIV和UIV+1平均HU值临界值为106,LL矫正值的临界值为22.5°.结论 应用S2AI螺钉骨盆固定的退行性脊柱畸形患者术前UIV和UIV+1平均HU值＜106、术后LL矫正值＞22.5°是发生PJK的独立危险因素.
Abstract
Objective To investigate the effect of Hounsfield Units(HU)at the upper instrumented vertebra(UIV)on postoperative proximal junctional kyphosis(PJK)after pelvic fixation with second sacral alar-iliac(S2AI)screws in patients with de-generative spinal deformity.Methods A total of 66 patients with degenerative spinal deformity who underwent pelvic fixation with S2AI screws from August 2015 to April 2021 were retrospectively reviewed.The cohort included 4 males and 62 females,aged 61.9±7.3 years(range,43-78 years),with a follow-up period of 18.4±14.3 months(range,6-60 months).The prevalence of PJK was 26％.Patients were divided into two groups based on the occurrence of PJK during postoperative follow-up:the PJK group(17 cases)and the non-PJK group(49 cases).HU measurements were taken at the UIV,the vertebral body cephalad to the UIV(UIV+1),and the L3 and L4 vertebral bodies.The following sagittal radiographic parameters were measured:thoracic kyphosis(TK),lum-bar lordosis(LL),sacral slope(SS),pelvic tilt(PT),pelvic incidence(PI),PI minus LL(PI-LL),and sagittal vertical axis(SVA)at preoperative,postoperative,and final follow-up.General information and HU values of the two groups were compared,and Pearson correlation analysis was performed on HU values,bone mineral density(BMD),and T scores.Logistic regression analysis was used to explore the risk factors for PJK.Results The HU values of L3 and L4 were significantly positively correlated with the BMD and T scores respectively(r=0.530,P＜0.001;r=0.537,P＜0.001).Age,gender,follow-up time,fixation levels,bone mineral density(BMD)and T-score were not significantly different between PJK and non-PJK group.The average HU values of UIV and UIV+1 in PJK group was 104.3±32.9,whlie the average HU values of UIV and UIV+1 in non-PJK group was 133.7±29.5.The difference of HU between the two groups was statistically significant(t=3.441,P=0.001).Logistic regression analysis showed that average HU values of UIV and UIV+1[OR=0.960,95％CI(0.933,0.987),P=0.004]and changes of lumbar lordosis[OR=1.049,95％CI(1.007,1.092),P=0.023]were independent risk factors for PJK,with an optimal cutoff obtained by ROC that 106 for average HU values of UIV and UIV+1 and 22.5° for changes of LL.Conclusion The average HU values of UIV and UIV+1＜106 and changes of lum-bar lordosis＞22.5° are independent risk factors for PJK after pelvic fixation with second sacralalar-iliac in patients with degenera-tive spinal deformity.
关键词
骨质疏松/骨密度/骨盆/成人脊柱畸形/近端交界性后凸/亨氏单位Key words
Osteoporosis/Bone density/Pelvis/Adult spinal deformity/Proximal junctional kyphosis/Hounsfield unit引用本文复制引用
基金项目
江苏省333高层次人才培养工程(20223-1-238)
江苏省医学创新中心(CXZX202214)
出版年
2024
NETL
NSTL
万方数据