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  • Title: [Analysis of factors associated with proximal junctional kyphosis after surgery for Lenke type 5 adolescent idiopathic scoliosis].
    Author: Li QD, He BR, Hui H, Gao L, Yang JS, Liu TJ, Zheng BL, Chang Z, Huang YF, Zhao ZG, Du JP, Hao DJ.
    Journal: Zhonghua Yi Xue Za Zhi; 2023 Aug 08; 103(29):2239-2245. PubMed ID: 37544760.
    Abstract:
    Objective: To investigate the risk factors associated with the development of proximal junctional kyphosis (PJK) after posterior spinal fusion for in children with Lenke type 5 adolescent idiopathic scoliosis (AIS). Methods: It was a retrospective case-control study that included medical records of 98 children with Lenke type 5 AIS who underwent posterior orthopedic surgery under general anesthesia at the Honghui Hospital Affiliated to Xi'an Jiaotong University from January 2013 to December 2018. There were 23 males and 75 females with a mean age of (14.5±2.2) years (10-18 years). Patients were divided into PJK and non-PJK groups according to whether the posterior junctional angle (PJA) was greater than 10° and increased for more than 10° from the preoperative period at the the last follow-up. Univariate analysis was used to analyze the correlation of general data of the children with occurrence of PJK after the operation. Multivariate logistic regression analysis was used to analyze the risk factors of postoperative PJK. Results: There were 35 cases in the PJK group and 63 cases in the non-PJK group. The PJK and non-PJK groups were followed up for (35.6±7.3) months and (36.4±7.5) months, respectively, and the difference was not statistically significant (P=0.637). There was no statistically significant difference between the two groups in general data such as gender, age, and body mass index (all P>0.05), while there were statistically significant differences between the two groups in upper instrumented vertebrea (UIV) location and junctional area posterior ligamentous complex (PLC) injury (all P<0.05). The results of univariate analysis showed that UIV location at T10-T12, junctional area PLC injury, preoperative coronal thoracic curve (TC), preoperative and final follow-up PJA, and preoperative and final follow-up pelvic incidence-lumbarlordosis (PI-LL) were correlated with postoperative PJK (OR=2.50, 5.37, 0.92, 1.12, 1.32, 1.06, 3.35, all P<0.05). Multifactorial logistic regression analysis showed that UIV located at T10-T12 (OR=2.346, 95%CI: 1.582-3.481, P=0.001), junctional area PLC injury (OR=5.112, 95%CI: 1.283-20.418, P=0.023) and last follow-up PI-LL (OR=1.826, 95%CI: 1.558-24.745, P=0.012) were risk factors for the occurrence of postoperative PJK in children with Lenke type 5 AIS. Conclusions: Postoperative UIV fixation to the thoracolumbar segment, PLC injury in the junctional area and excessive postoperative PI-LL in children with Lenke type 5 AIS may be the risk factors for the occurrence of PJK after the operation. It is suggested that avoidance of UIV selection to the thoracolumbar segment, intraoperative protection of the PLC located near the UIV and restoration of a good PI-LL relationship may reduce the incidence of PJK. 目的： 探讨Lenke 5型青少年特发性脊柱侧凸（AIS）后路矫形术后近端交界性后凸（PJK）发生的相关危险因素。 方法： 本研究为回顾性病例对照研究，纳入2013年1月至2018年12月于西安交通大学附属红会医院行全身麻醉下后路矫形术治疗的98例Lenke 5型AIS患儿的病历资料。98例患儿中，男23例，女75例，年龄（14.5±2.2）岁（10~18岁）。根据末次随访时，交界性后凸角（PJA）是否大于10°且较术前增加大于10°以上，将患儿分为PJK组和非PJK组。采用单因素分析患儿临床及影像学资料与术后PJK发生的相关性。采用多因素logistic回归分析与术后PJK发生的危险因素。 结果： 纳入研究的98例行后路矫形术治疗的Lenke 5型AIS患儿中，PJK组35例，非PJK组63例。PJK组和非PJK组分别随访（35.6±7.3）和（36.4±7.5）个月，差异无统计学意义（P=0.637）。两组性别、年龄、体质指数等一般资料比较差异均无统计学意义（均P>0.05），而两组上端固定椎（UIV）位置和交界区后方韧带复合体（PLC）损伤情况比较差异均有统计学意义（均P<0.05）。单因素分析显示，UIV位于T10~T12、交界区PLC损伤、术前冠状位胸弯角（TC）、术前及末次随访交界性后凸角（PJA）、术前及末次随访骨盆入射角-腰椎前凸角差值（PI-LL）均与术后PJK发生有一定的相关性（OR=2.50、5.37、0.92、1.12、1.32、1.06、3.35，均P<0.05）。多因素logistic回归分析表明，UIV位于T10~T12（OR=2.346，95%CI： 1.582~3.481，P=0.001）、交界区PLC损伤（OR=5.112，95%CI： 1.283~20.418，P=0.023）及末次随访PI-LL（OR=1.826，95%CI： 1.558~24.745，P=0.012）是Lenke 5型AIS患儿术后PJK发生的危险因素。 结论： Lenke 5型AIS患儿术后UIV固定至胸腰段、交界区的PLC损伤及术后PI-LL过大可能是PJK发生的危险因素，建议UIV避免选至胸腰段、术中保护位于UIV附近的PLC及恢复良好的PI-LL关系可降低PJK的发生率。.
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