摘要
目的探讨改良整体形态与平衡评分 (modified global alignment and proportion,M-GAP) 预测成人脊柱畸形 (adult spinal deformity,ASD) 长节段矫形固定术后机械并发症的可行性。方法回顾性分析 2016 年 1 月至 2018 年 1 月接受长节段 (≥ 4 个节段) 固定融合手术、随访时间≥ 3 年的 150 例 ASD 患者临床资料,其中男 49 例,女 101 例;年龄 61~84 岁,平均 (68.1±6.2) 岁。在术后全脊柱正侧位 X 线片上测量所有患者的骨盆入射角 (pelvic incidence,PI)、骶骨倾斜角 (sacral slope,SS)、腰椎前凸角 (lumbar lordosis,LL)、躯干整体倾斜角 (global tilt,GT) 及矢状面平衡 (sagittal vertical axis,SVA)。根据 PI 值计算出理想矢状面参数。M-GAP 评分包括相对骨盆倾斜 (relative pelvic version,RPV)=实际测量 SS-理想 SS,相对腰椎前凸(relative lumbar lordosis,RLL)=实际测量 LL-理想 LL,腰椎前凸分布指数 (lordosis distribution index,LDI)=下腰椎前凸 (lower lumbar lordosis,LLL) / LL,相对脊柱骨盆平衡 (relative spinopelvic alignment,RSA)=实际测量 GT-理想 GT。将其分为"协调""中等不协调""严重不协调"三组。机械性并发症如近端交界性后凸 / 失败 (proximal junctional kyphosis / failure,PJK / PJF)、不融合及内固定相关并发症 (螺钉松动、断裂、拔出,断棒)。对 M-GAP 生成预测机械性并发症发生应用标准受试者工作特征 (receiver operating characteristic,ROC)曲线的曲线下面积 (the area under the ROC curve,AUC) 值判断 M-GAP 的预测准确性。M-GAP 评分的三种评估结果间机械性并发症发生率比较采用 Pearson χ2 检验,并采用线性趋势检验评估评分结果与力学并发症发生率是否存在线性趋势。结果在所有患者中,86 例 (57.3%) 发生了机械性并发症,5 例 (3.3%) 因机械性并发症再次行手术治疗。M-GAP 评分结果为"协调"者 45 例 (30.0%)、"中等不协调"者 69 例 (46.0%) 及"严重不协调"者 36 例 (24.0%),术后机械性并发�
Objective To investigate the feasibility of predicting mechanical complications after long segment corrective surgeries in adult spinal deformity with modified global alignment and proportion score (M-GAP).Methods We retrospectively reviewed the data of 150 patients after long segment (≥ 4 levels) corrective surgeries for adult spinal deformity from January 2016 to January 2018.All were followed up ≥ 3 years in Beijing Xuanwu Hospital,including 49 males and 101 females aged 61-84 years (mean:68.1±6.2 years).Values of spinal and pelvic parameters including pelvic incidence (PI),sacral slope (SS),spine lordosis (LL),global tilt (GT) and sagittal vertical axis (SVA) were measured on lateral full-spine X-rays after surgery.The ideal sagittal plane parameters were calculated according to PI values.M-GAP parameters included relative pelvic version (the measured minus the ideal SS),relative lumbar lordosis (lower lumbar lordosis divided by LL),lordosis distribution index (L4-S1 lordosis divided by the L1-S1 lordosis multiplied by 100),relative spinopelvic alignment (the measured minus the ideal GT),and an age factor.The cohort was divided into three subgroups as proportioned,moderately disproportioned and severely disproportioned.Proximal and distal junctional kyphosis and / or failure (PJK / PJF),complications related to non-fusion and internal fixation (screw loosening,fracture,pull-out,broken rod) were considered as mechanical complications.The predictive accuracy of the M-GAP score was analyzed using receiver operating characteristic(ROC) analysis.Incidence of mechanical complications between M-GAP categories and mechanical complications was compared using Pearson chi-square test,and linear trend test was used to evaluate whether there was a linear trend between the assessment results.Results In the cohort,86 (57.3%) developed mechanical complications,and 5 (3.3%)underwent reoperation due to mechanical complications.Postoperatively,45 (30.0%) patients with a proportioned spinopelvic state according to the M-GAP
作者
王宇
孙文志
孙祥耀
胡海量
王鹏
孔超
张思韬
鲁世保
WANG Yu;SUN Wen-zhi;SUN Xiang-yao;HU Hai-liang;WANG Peng;KONG Chao;ZHANG Si-tao;LU Shi-bao(Department of Orthopedics,Xuanxvu Hospital,Capital Medical University,Beijing,100053,China)
出处
《中国骨与关节杂志》
CAS
2021年第9期706-711,共6页
Chinese Journal of Bone and Joint
基金
北京市属医学科研院所公益发展改革试点项目(京医研2019-2)。
关键词
脊柱弯曲
脊柱融合术
手术后并发症
Spinal curvatures
Spinal fusion
Postoperative complications
