休门氏病矫形术后近端交界区后凸的发生率及危险因素的Meta分析

A Meta-analysis of the incidence and risk factors of proximal junctional kyphosis after correction surgery for Scheuermann′s disease

中文关键词:  休门氏病  近端交界性后凸  危险因素  Meta分析

英文关键词:Scheuermann′s disease  Proximal junctional kyphosis  Risk factors  Meta analysis

中文摘要:

  【摘要】 目的：通过Meta分析探讨休门氏病（Scheuermann′s disease）矫形术后近端交界区后凸（proximal junctional kyphosis，PJK）的发生率及相关危险因素。方法：检索PubMed、Embase、Cochrane Library、中国知网以及万方数据库（从建库到2021年11月），对休门氏病患者矫形术后发生PJK的相关研究进行检索。采用纽卡斯-渥太华量表（Newcastle-Ottawa Scale，NOS）对纳入研究进行质量评价，提取纳入研究的结局指标，包括PJK的发生率、年龄、性别、手术术式、近端固定椎（proximal instrumented vertebra，PIV）相较于近端转向椎（proximal end vertebra，PEV）的位置、PIV的位置、脊柱后凸矫正量、骨盆入射角（pelvic incidence，PI）、术前与术后腰椎前凸（lumbar lordosis，LL）、术前与术后骨盆倾斜度（pelvic tilt，PT）、术前与术后骶骨斜坡（sacral slope，SS）、术前与术后胸椎后凸（thoracic kyphosis，TK）、PI-LL、矫正的丢失度、TK矫正率。用Revman 5.3软件进行统计分析。使用固定或随机效应模型，单个率采用优势比（odds ratios，OR），连续性变量采用加权平均差异（weighted mean difference，WMD），并给出可信区间（confidence interval，CI）为95%。结果：共纳入17篇文献，均为高质量队列研究。总计784例患者，其中213例休门氏病患者在矫形手术后发生了PJK（PJK组213例），非PJK组571例，随访时间为35.72±14.16个月。Meta分析结果显示，PJK的总发生率为23%（RD 0.23，95%CI 0.13~0.33，P<0.00001）；PIV的位置（OR 0.37，95%CI 0.16~0.85，P=0.02）、脊柱后凸的矫正量（OR 4.52，95%CI 1.72~11.90，P=0.002）两组之间存在统计学差异，当PIV的固定位置在T5~T8之间PJK的发生率显著上升，当脊柱后凸的矫正量>50%时PJK的发生率也显著上升；而PI（WMD -1.51，95%CI -4.75~1.73，P=0.36）、年龄（WMD 0.15，95%CI -1.80~2.09，P=0.88），性别（OR 1.08，95%CI 0.39~2.97，P=0.88）、手术术式（OR 1.2，95%CI 0.65~2.22，P=0.55）、PIV相较于PEV的位置（OR 0.6，95%CI 0.32~1.14，P=0.12）、术前LL（WMD -1.22，95%CI -5.86~3.41，P=0.60）、术后LL（WMD -1.43，95%CI-6.02~3.16，P=0.54）、术前PT（WMD 0.63，95%CI -1.82~3.08，P=0.62）、术后PT（WMD 4.03，95%CI -1.71~9.78，P=0.17）、术前SS（WMD -0.10，95%CI -3.40~3.19，P=0.95）、术后SS（WMD -1.15，95%CI -3.95~1.67，P=0.42）、术前TK（WMD 1.38，95%CI -1.21~3.98，P=0.30）、术后TK（WMD 3.13，95%CI -0.56~6.817，P=0.10）、PI-LL（WMD -2.40，95%CI -6.92~2.12，P=0.30）、矫正的丢失度（WMD -0.49，95%CI -2.92~1.93，P=0.69）及TK的矫正率（WMD -4.22，95%CI -12.63~4.18，P=0.32）两组之间均无统计学差异。结论：休门氏病患者矫形术后PJK的发生率为23%，当PIV的固定位置在T5~T8之间时，PJK的发生率显著上升；当脊柱后凸的矫正量>50%时，PJK的发生率也显著上升。

英文摘要:

  【Abstract】 Objectives: To investigate the incidence of proximal junctional kyphosis (PJK) after orthopaedic surgery for Scheuermann′s disease and associated risk factors through Meta-analysis. Methods: Database such as PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched from inception to November 2021 for studies related to the occurrence of PJK in patients with Scheuermann′s disease after orthopedics surgery. The Newcastle-Ottawa Scale(NOS) was used to evaluate the quality of the included studies, and the outcome indicators of the included studies were extracted, including the incidence of PJK, age and gender, the surgical procedure, relative position of proximal instrumented vertebra(PIV) to proximal end vertebra(PEV), the position of PIV, the amount of kyphosis correction, the pelvic incidence(PI), and pre- and post-operative lumbar lordosis(LL), pelvic tilt(PT), sacral slope(SS), and thoracic kyphosis(TK), PI-LL, correction loss, and TK correction rate. Statistical analyses were performed using Revman 5.3 software. A fixed or random effects model was used with odds ratios(OR) for single rate and weighted mean difference(WMD) for continuous variables, and confidence intervals CI was 95%. Results: A total of 17 high quality cohort studies were included in this meta-analysis, involving 784 patients, of which 213 patients with Scheuermann′s disease developed PJK after corrective surgery(PJK group) and the other 571 cases were included in non-PJK group. The follow-up time was 35.72±14.16 months. Meta-analysis showed that the overall incidence of PJK was 23%(RD 0.23, 95%CI 0.13-0.33, P<0.00001), and there were significant differences between groups in PIV position(OR 0.37, 95%CI 0.16-0.85, P=0.02) and the amount of correction of kyphosis(OR 4.52, 95%CI 1.72-11.90, P=0.002), with a significantly higher incidence of PJK when the fixed position of the upper vertebrae was between T5 and T8 and also when the amount of kyphosis correction was >50%. There was no significant difference between groups in PI(WMD -1.51, 95%CI -4.75-1.73, P=0.36), age(WMD 0.15, 95%CI -1.80-2.09, P=0.88), sex(OR 1.08, 95%CI 0.39-2.97, P=0.88), surgical procedure(OR 1.2, 95%CI 0.65-2.22, P=0.55), relative position of PIV to PEV(OR 0.6, 95%CI 0.32-1.14, P=0.12), preoperative LL(WMD -1.22, 95%CI -5.86-3.41, P=0.60), postoperative LL(WMD -1.43, 95%CI -6.02-3.16, P=0.54), preoperative PT(WMD 0.63, 95%CI -1.82-3.08, P=0.62), postoperative PT(WMD 4.03, 95%CI -1.71-9.78, P=0.17), preoperative SS(WMD -0.10, 95%CI -3.40-3.19, P=0.95), postoperative SS(WMD -1.15, 95%CI -3.95-1.67, P=0.42), preoperative TK(WMD 1.38, 95%CI -1.21-3.98, P=0.30), postoperative TK(WMD 3.13, 95%CI -0.56-6.817, P=0.10), PI-LL(WMD -2.40, 95%CI -6.92-2.12, P=0.30), correction loss (WMD -0.49, 95%CI -2.92-1.93, P=0.69), and correction rate of TK(WMD -4.22, 95%CI -12.63-4.18, P=0.32). Conclusions: The incidence of PJK after orthopaedic surgery in patients with Scheuermann′s disease was 23%, with a significant increase in the incidence of PJK when the fixation position of the upper vertebrae was between T5 and T8 and when the amount of kyphosis correction was >50%.