中国组织工程研究 ›› 2020, Vol. 24 ›› Issue (3): 460-468.doi: 10.3969/j.issn.2095-4344.2420

• 骨与关节循证医学 evidence-based medicine of the bone and joint • 上一篇    下一篇

脊柱矫形后发生近端交界性后凸危险因素的荟萃分析

张  健1,2,王小健2,秦德安2,赵中涛2,梁庆元2,安奇君2,宋洁富2   

  1. 1山西医科大学,山西省太原市  030001;2山西医科大学附属人民医院,山西省太原市  030012
  • 收稿日期:2019-06-19 修回日期:2019-06-21 接受日期:2019-07-24 出版日期:2020-01-28 发布日期:2019-12-27
  • 通讯作者: 宋洁富,主任医师,硕士生导师,山西医科大学附属人民医院骨科,山西省太原市 030012
  • 作者简介:张健,男,1991年生,山西省太原市人,汉族,山西医科大学在读硕士,主要从事脊柱外科方面的研究。
  • 基金资助:
    国家自然科学基金(8157090774);山西省重点研发计划项目(201803D31160);山西省基础研究项目(2015011121)

Risk factors for proximal junctional kyphosis after spinal deformity surgery: a meta-analysis

Zhang Jian1, 2, Wang Xiaojian2, Qin Dean2, Zhao Zhongtao2, Liang Qingyuan2, An Qijun2, Song Jiefu2   

  1. 1Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; 2People’s Hospital Affiliated to Shanxi Medical University, Taiyuan 030012, Shanxi Province, China
  • Received:2019-06-19 Revised:2019-06-21 Accepted:2019-07-24 Online:2020-01-28 Published:2019-12-27
  • Contact: Song Jiefu, Chief physician, Master’s supervisor, People’s Hospital Affiliated to Shanxi Medical University, Taiyuan 030012, Shanxi Province, China
  • About author:Zhang Jian, Master candidate, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China; People’s Hospital Affiliated to Shanxi Medical University, Taiyuan 030012, Shanxi Province, China
  • Supported by:
    the National Natural Science Foundation of China, No. 8157090774; the Key Research and Development Program of Shanxi Province, No. 201803D31160; the Basic Research Project of Shanxi Province, No. 2015011121

摘要:

文题释义:
近端交界性后凸:是脊柱矫形术后出现的并发症之一,通常因手术近端内固定交界区的应力改变引起,是一种与脊柱融合相关的邻近节段疾病。
近端交界区后凸角:采用 Cobb 角测量法测量,它被定义为最上端固定椎体的下终板和上2个相邻椎体的上终板之间的后凸角,若该后凸角大于10°,且同术前相比增加10°以上,则认为发生了近端交界性后凸。

背景:对于实施脊柱畸形矫形的患者,近端交界性后凸是术后常见的并发症,可导致成年人和青少年脊柱畸形患者多种不良临床预后。因此,有必要对可能导致矫形术后患者发生近端交界性后凸的危险因素进行分析,以扩大对近端交界性后凸的认识并为预防其发生提供指导。

目的:通过荟萃分析评价影响脊柱畸形矫形术后发生近端交界性后凸畸形的危险因素。

方法:在PubMed、EMbase、Cochrane、中国知网和万方医学检索截止至2019年5月发表的公开文献,严格评价文献质量,根据纳入标准和排除标准选择文献,收集相关数据,使用RevMan 5.3软件统计分析相关数据,评估荟萃分析结果。

结果与结论:①共纳入26篇文献,总计4 498例患者,其中921例患者术后发生近端交界性后凸,经分析后显示脊柱矫形术后近端交界性后凸发生率为25%;②年龄,体质量指数,骨质疏松,手术椎体数量,最上端固定椎体至胸腰段(T10-L1),最下端固定椎体固定至骶骨/骨盆/髂骨,术后近端交界区后凸角、腰椎前凸角和矢状面垂直偏移,术前术后近端交界区后凸角变化、腰椎前凸角变化和矢状面垂直偏移变化,以上指标在近端交界性后凸患者和非近端交界性后凸患者之间差异有显著性意义(P < 0.05);③而性别、截骨、前后联合手术、术前近端交界区后凸角、术前腰椎前凸角在近端交界性后凸患者和非近端交界性后凸患者之间差异无显著性意义(P > 0.05);④该荟萃分析显示,非手术因素中高龄、体质量指数、骨质疏松;手术因素中固定节段> 5个椎体,最上端固定内固定至胸腰段,最下端固定至骶骨/骨盆/髂骨,术后近端交界区后凸角、腰椎前凸角、矢状面垂直偏移,术前术后近端交界区后凸角、腰椎前凸角、矢状面垂直偏移变化较大是近端交界性后凸发生的主要危险因素。可通过干预高危人群及手术方案的制定,降低近端交界性后凸的发生率。由于多种非手术因素和手术因素共同作用产生近端交界性后凸,仍需进行更严谨的流行病学研究为减少近端交界性后凸的发生提供可靠证据。

ORCID: 0000-0002-1890-0731(张健)

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

关键词: 脊柱矫形, 近端交界性后凸, 畸形, 危险因素, 荟萃分析, 国家自然科学基金

Abstract:

BACKGROUND: Proximal junctional kyphosis is a common complication after spinal deformity surgery, which can lead to a variety of adverse clinical outcomes. Therefore, it is necessary to analyze the risk factors that may lead to proximal junctional kyphosis after surgery, in order to expand our understanding of proximal junctional kyphosis and provide guidance for its prevention.

OBJECTIVE: To evaluate the risk factors of proximal junctional kyphosis after spinal deformity surgery using meta-analysis.

METHODS: A systematic literature search was performed using PubMed, EMbase, Cochrane, CNKI and Wanfang Medical Database (up to May 2019). The quality of literatures was assessed and selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted. RevMan 5.3 software was used for data analysis and the data were dealt by meta-analysis. The meta-analysis results were evaluated.

RESULTS AND CONCLUSION: (1) This study included 26 studies involving 4 498 patients of whom 921 with proximal junctional kyphosis. The incidence of proximal junctional kyphosis after spinal orthopedic surgery was 25%. (2) There were significant differences between the proximal junctional kyphosis and non-proximal junctional kyphosis groups in age, body mass index, osteoporosis, number of surgical vertebral bodies, the upper instrumented vertebra to the thoracolumbar segment (T10-L1), the lower instrumented vertebra to the sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis (P < 0.05). (3) There were no significant differences in gender, osteotomy, combined surgery, preoperative proximal kyphosis angle or preoperative lumbar lordosis (P > 0.05). (4) Our meta-analysis showed that age, body mass index, osteoporosis, the number of operative vertebrae > 5 at fixation segment, the upper instrumented vertebra internal fixation to thoracolumbar segment (T10-L1), the lower instrumented vertebra fixation to sacrum/pelvis/ilium, postoperative proximal kyphosis angle, lumbar lordosis and sagittal vertical axis, changes in proximal kyphosis angle, lumbar lordosis and sagittal vertical axis were the main risk factors for proximal junctional kyphosis. The incidence of proximal junctional kyphosis can be reduced by intervening the high-risk population and making the suitable surgical procedures. Proximal junctional kyphosis was due to a variety of non-surgical and surgical factors. More rigorous epidemiological studies are needed to provide reliable evidence for reducing the incidence of proximal junctional kyphosis.

Key words: spinal deformity surgery, proximal junctional kyphosis, deformity, risk factors, meta-analysis, the National Natural Science Foundation of China

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