经伤椎短节段内固定治疗单节段胸腰椎爆裂骨折术后再发后凸畸形的危险因素分析

The risk factor analysis of kyphosis reccurrence in single level thoracolumbar burst fracture after short-segment instrumentation in fractured vertebra

中文关键词:  胸腰椎骨折  爆裂骨折  内固定术  再发后凸畸形  危险因素

英文关键词:Thoracolumbar fracture  Burst fracture  Internal fixation  Kyphosis reccurrence  Risk factor

中文摘要:

  【摘要】 目的：分析单节段胸腰椎爆裂骨折患者后路经伤椎短节段内固定术（SSPI-f）治疗后内固定取出前及内固定取出后再发后凸畸形（kyphosis recurrence，KR）的危险因素。方法：收集2014年1月～2016年1月在本研究合作单位行SSPI-f治疗的单节段胸腰椎爆裂骨折患者的资料，获取患者年龄、骨折节段后凸Cobb角（Cobb angle，CA）、局部Cobb角（regional angle，RA）、椎体楔形角（vertebral wedge angle，VWA）、椎体前缘高度比值（anterior vertebra height ratio，AVH）、椎体后缘高度比值（posterior vertebra height ratio，PVH）、椎体前后缘高度比值（anteroposterior ratio，A/P）、上位椎间盘角（upper intervertebral angle，UIVA）、下位椎间盘角（lower intervertebral angle，LIVA）、体重指数（body mass index，BMI）、视觉模拟评分（visual analogue scale，VAS）、胸腰椎损伤分类及损伤程度评分系统（thoracolumbar injury classification and severity score，TLICS）评分、载荷评分（load-sharing classification，LSC）、糖尿病病史。将术后矫正度丢失＞10°定义为术后KR。按照术后有无KR将其分为KR组与无KR组（NKR组），并将其按照取出内固定前以及取出内固定后分别进行分析。采用Logistic回归分析筛选危险因素，通过ROC曲线分析计算阈值。结果：共纳入5个研究中心的196例患者，内固定取出前发生KR 14例（KR组），将KR组与NKR组进行比较后发现，年龄（P＜0.001）、BMI（P＜0.001）为取出内固定前发生KR的危险因素；年龄临界值为58.5岁[曲线下面积（AUC）=0.885]，BMI临界值为29.1kg/m2（AUC=0.962）。内固定取出后总体矫正度丢失7.5°±4.4°，其中65例（33.2%）患者出现KR；将KR组与NKR组进行比较后发现，女性（P＜0.001）、年龄（P＜0.001）、BMI（P＜0.001）、L1骨折（P＜0.001）、A3.3型骨折（P=0.001）、术前UIVA（P=0.014）为取出内固定后发生KR的危险因素；T12骨折（P＜0.001）、A3.1型骨折（P＜0.001）、术前AVH大（P＜0.001）为保护因素；年龄临界值为50.5岁（AUC=0.789），BMI临界值为26.6kg/m2（AUC=0.740），术前UIVA临界值为-4.2°（AUC=0.650），术前AVH临界值为60.5%（AUC=0.254）。结论：年龄＞58.5岁、BMI＞29.1kg/m2为单节段胸腰椎爆裂骨折经伤椎短节段内固定术后内固定取出前发生KR的危险因素；女性、年龄＞50.5岁、BMI＞26.6kg/m2、L1骨折、A3.3型骨折、术前UIVA＞-4.2°为取出内固定后发生KR的危险因素，T12骨折、A3.1型骨折、术前AVH＞60.5%为保护因素。

英文摘要:

  【Abstract】 Objectives: To analyze the risk factors of kyphosis reccurrence in thoracolumbar burst fracture before or after implant removal after short-segment instrumentation in fractured vertebra. Methods: From January 2014 to January 2016, patients with thoracolumbar burst fracture who underwent posterior short-segment pedicle screw instrumentation in the cooperation units were carefully reviewed. The followings were obtained: age, Cobb angle of the fractured segment(CA), regional angle(RA), vertebral wedge angle(VWA), anterior vertebra height ratio(AVH), posterior vertebra height ratio(PVH), anteroposterior ratio(A/P), upper intervertebral angle(UIVA), lower intervertebral angle(LIVA), body mass index(BMI), visual analogue scale(VAS), thoracolumbar injury classification and severity score(TLICS), load-sharing classification(LSC), history of diabetes. Posterior kyphosis reccurrence was defined as posterior correction loss >10°. The patients were divided into kyphosis recurrence(KR) group and none kyphosis recurrence(NKR) group. The parameters were analyzed according to before or after implant removal. Logistic regression was used to analyze the risk factors. The threshold value was calculated by ROC curve analysis. Results: A total of 196 patients from 5 cooperation units were included in this study. When KR group was compared with NKR group before implant removal, age(P<0.001) and BMI(P<0.001) were risk factors of kyphosis reccurrence; age >58.5 years[area under curve(AUC)=0.885], BMI >29.1kg/m2(AUC=0.962) were the thresholds. When KR group was compared with NKR group after implant removal, female(P<0.001), age(P<0.001), BMI(P<0.001), L1 fracture(P<0.001), AO classification of A3.3(P=0.001), preoperative UIVA(P=0.014) were the risk factors of kyphosis reccurrence after implant removal; T12 fracture(P＜0.001), AO classification of A3.1(P<0.001), preoperative AVH(P＜0.001) were the protective factors; age >50.5 years(AUC=0.789), BMI >26.6kg/m2(AUC=0.740), preoperative UIVA >-4.2°(AUC=0.650), preoperative AVH >60.5% were the thresholds. Conclusions: Before implant removal, age >58.5 years and BMI >29.1kg/m2 are the risk factors of kyphosis reoccurrence in single level thoracolumbar burst fracture after short-segment instrumentation. After implant removal, age >50.5 years(AUC=0.789), BMI >26.6kg/m2(AUC=0.740), preoperative UIVA >-4.2°(AUC=0.650), L1 fracture, AO classification of A3.3 are the risk factors of kyphosis reoccurrence; T12 fracture, AO classification of A3.1 and preoperative AVH >60.5% are the protective factors of kyphosis reccurrence.