骨质疏松性椎体压缩骨折后凸矫形内固定术后并发症与椎旁肌退变的相关性
Correlation between postoperative complications and paravertebral muscle degeneration in osteoporotic vertebral com-pression fracture with kyphotic deformity
李君禹 1王子墨 2韩耕愚 1孙卓然 1王永强 1于淼 1李危石 1曾岩1
作者信息
- 1. 北京大学第三医院骨科,北京 100089
- 2. 北京大学医学部,北京 100191
- 折叠
摘要
目的 探讨陈旧性骨质疏松性椎体压缩骨折(osteoporotic vertebral compression fracture,OVCF)后凸矫形内固定术后的机械并发症与椎旁肌退变的相关性.方法 回顾性分析2008年1月至2021年1月于北京大学第三医院接受后路单节段截骨后凸矫形内固定术治疗OVCF后凸畸形患者80例,男17例、女63例,年龄(63.21±8.07)岁(范围47～77岁).术后机械并发症包括近端交界性后凸(proximal junctional kyphosis,PJK)、螺钉松动、邻近节段退变(adjacent segment degeneration,ASD)、远端交界性后凸及失败.比较发生和未发生机械并发症患者的多裂肌脂肪浸润率(fat infiltration,FI)、相对总横截面积(relative gross cross-sectional area,rGCSA)、相对功能性横截面积(relative functional cross-sectional ar-ea,rFCSA).使用二分类变量logistic回归分析确定导致术后并发症的危险因素.结果 80例患者中19例发生PJK、61例未发生,PJK组多裂肌FI(0.44±0.05)高于无PJK组(0.38±0.10),差异有统计学意义(P＜0.05);7例发生螺钉松动、73例未发生,螺钉松动组多裂肌FI(0.47±0.05)高于无螺钉松动组(0.38±0.09),差异有统计学意义(P＜0.05);30例发生ASD、50例未发生,ASD 组多裂肌 FI(0.45±0.07)高于无 ASD 组(0.36±0.10)、rFCSA(0.09±0.03)低于无 ASD 组(0.13±0.06),差异有统计学意义(P＜0.05),logistic回归分析提示多裂肌FI、rFCSA不是发生ASD的独立危险因素;23例发生远端交界性后凸及失败、57例未发生,远端交界性后凸及失败组多裂肌FI(0.48±0.08)高于无远端交界性后凸及失败组(0.37±0.09),rGCSA(0.16±0.04)和rFCSA(0.09±0.03)低于无远端交界性后凸及失败组(0.20±0.09和0.13±0.06),差异有统计学意义(P＜0.05),logistic回归分析提示多裂肌FI、rGCSA和rFCSA均不是发生远端交界性后凸及失败的独立危险因素.结论 陈旧性OVCF后凸矫形内固定术后发生PJK、螺钉松动、ASD和远端交界性后凸及失败可能与较高的多裂肌FI相关,且发生ASD和远端交界性后凸及失败可能也与较小的多裂肌rFCSA相关.
Abstract
Objective To explore the correlation between mechanical complications and paraspinal muscle degeneration following posterior single-segment osteotomy corrective surgery for chronic osteoporotic vertebral compression fractures(OVCF).Methods A retrospective analysis was conducted on 80 patients who underwent surgery between January 2008 and January 2021 at Peking University Third Hospital.These patients,who developed kyphotic deformity following OVCF,included 17 males and 63 females with a mean age of 63.21±8.07 years(range,47-77 years).Postoperative mechanical complications included proxi-mal junctional kyphosis(PJK),screw loosening,adjacent segment degeneration(ASD),and distal junctional kyphosis or failure.Pa-tients were compared based on the occurrence of mechanical complications in relation to fat infiltration(FI),relative gross cross-sectional area(rGCSA),and relative functional cross-sectional area(rFCSA)of the paraspinal muscles.Binary logistic regression analysis was used to identify risk factors for postoperative complications.Results Among the 80 patients,19 developed PJK,while 61 did not.The PJK group exhibited significantly higher paraspinal muscle FI(0.44±0.05)compared to the non-PJK group(0.38±0.10,P＜0.05).Screw loosening occurred in 7 cases,with 73 cases remaining stable.Those with screw loosening demonstrat-ed higher paraspinal muscle FI(0.47±0.05)than those without(0.38±0.09,P＜0.05).Thirty patients experienced ASD,while 50 did not.The ASD group had higher paraspinal muscle FI(0.45±0.07)and lower rFCSA(0.09±0.03)compared to the non-ASD group(0.36±0.10 and 0.13±0.06,respectively,P＜0.05).Logistic regression analysis indicated that paraspinal muscle FI and rFC-SA were not independent risk factors for developing ASD.Twenty-three patients experienced distal junctional kyphosis or failure,while 57 did not;those with complications exhibited higher paraspinal muscle FI(0.48±0.08)and lower rGCSA(0.16±0.04)and rFCSA(0.09±0.03)compared to those without complications(0.37±0.09,0.20±0.09,and 0.13±0.06,respectively,P＜0.05).Logis-tic regression analysis suggested that paraspinal muscle FI,rGCSA,and rFCSA were not independent risk factors for developing distal junctional kyphosis or failure.Conclusion Mechanical complications following corrective surgery for chronic OVCF-relat-ed kyphosis may be associated with increased paraspinal muscle FI.Additionally,the occurrence of ASD and distal junctional ky-phosis or failure may correlate with reduced paraspinal muscle rFCSA.
关键词
骨质疏松性骨折/脊柱后凸/手术后并发症/椎旁肌/危险因素Key words
Osteoporotic fractures/Kyphosis/Postoperative complications/Paraspinal muscles/Risk factors引用本文复制引用
出版年
2024
NETL
NSTL
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