修正矢状位年龄校正评分对国人成人脊柱畸形术后发生PJK/PJF预测能力的研究

Effectiveness of modified sagittal age-adjusted score in predicting the occurrence of PJK/PJF after corrective surgery of spinal deformity in Chinese adults

中文关键词:  成人脊柱畸形  SAAS评分  近端交界性后凸  术后并发症

英文关键词:Adult spinal deformity  Sagittal age-adjusted score  Proximal junctional kyphosis  Postoperative complications

中文摘要:

  【摘要】 目的：评价矢状位年龄校正评分（sagittal age-adjusted score，SAAS）和以国人年龄匹配脊柱为基线修正的SAAS评分（M-SAAS）预测国人成人脊柱畸形（adult spinal deformity，ASD）术后发生近端交界性后凸/失败（proximal junctional kyphosis/failure，PJK/PJF）的能力。方法：收集来自我院影像学系统66例年龄匹配脊柱-骨盆序列的受试者资料，其中男性28例，女性38例，年龄54.7±6.2岁，测量骨盆入射角（pelvic incidence，PI）、腰椎前凸角（lumbar lordosis，LL）、骨盆倾斜角（pelvic tilt，PT）以及T1骨盆角（T1-pelvic-angle，TPA）并统计分析年龄与PI-LL、PT以及TPA的线性回归方程，将公式记为M-SAAS。回顾性分析68例于2017～2021年在我院行脊柱矫形术的ASD患者病历资料，其中男性10例，女性58例，年龄64.0±8.1岁，术后PJK/PJF发生12例。测量PI、LL、PT以及TPA，计算SAAS评分并观察PJK/PJF发生率与评分的匹配程度。将68例ASD患者术后影像学参数代入M-SAAS，计算M-SAAS评分并观察PJK/PJF发生率与评分的匹配程度。结果：SAAS评分为1.9±2.6分（-4~6分），术后即刻评估为“矫正不足”“匹配”及“过度矫正”的患者分别为5例（7.4%）、25例（36.7%）和38例（55.9%），PJK/PJF发生率分别为40.0%（2/5）、20.0%（5/25）和13.2%（5/38），匹配组PJK/PJF发生率与另两组差异无统计学意义。依据正常脊柱-骨盆序列得M-SAAS线性回归方程为：理想PI-LL=0.47×（年龄-55）+0.3、理想PT=0.44×（年龄-55）+14和理想TPA=0.37×（年龄-55）+9。ASD患者最终M-SAAS分数为0.2±2.8分（-5~5分），术后即刻被评估为“矫正不足”“匹配”及“过度矫正”的患者分别为17例（25.0%）、31例（45.6%）和20例（29.4%），术后PJK/PJF发生率分别为11.8%（2/17）、6.5%（2/31）和40.0%（8/20），“过度矫正”组PJK/PJF发生率高，与“匹配”组差异有统计学意义（P=0.008）。结论：SAAS不适用于对国人ASD患者术后发生PJK/PJF的预测评价，根据国人中老年年龄匹配脊柱-骨盆序列参数关系修正的M-SAAS可预测ASD患者术后发生PJK/PJF的概率。

英文摘要:

  【Abstract】 Objectives: To evaluate the abilities of sagittal age-adjusted score(SAAS) and modified SAAS score(M-SAAS) based on Chinese age-matched spine in predicting proximal junctional kyphosis/failure(PJK/PJF) after corrective surgery for patients with adult spinal deformity(ASD) in Chinese adults. Methods: The pelvic incidence(PI), lumbar lordosis(LL), pelvic tilt(PT), and T1-pelvic-angle(TPA) were measured in 66 subjects of age matched with spino-pelvic sequence from the imaging system of our hospital, including 28 males and 38 females, aged 54.7±6.2 years. The linear regression equations of age and PI-LL, PT and TPA were analyzed and recorded as M-SAAS formulas. The medical records of 68 ASD patients who underwent spinal correction surgery in our hospital from 2017 to 2021 were retrospectively analyzed, including 10 males and 58 females, aged 64.0±8.1 years old, and postoperative PJK/PJF occurred in 12 cases. Data such as PI, LL, PT and TPA were measured to calculate the SAAS score and the matching degree between the incidence of PJK/PJF and the score was observed. M-SAAS was calculated by substituting the postoperative imaging parameters of 68 ASD patients, and the matching degree between the incidence of PJK/PJF and the score was observed. Results: The SAAS was 1.9±2.6(range, -4 to 6). Immediately after surgery, 5 patients(7.4%) were evaluated as "Under-corrected", 25 patients(36.7%) as "Matched", and 38 patients(55.9%) as "Over-corrected". The incidence of PJK/PJF was 40.0%(2/5), 20.0%(5/25) and 13.2%(5/38), respectively. There was no significant difference in the incidence of PJK/PJF between the matched group and the other two groups. According to the normal spino-pelvic sequence, the linear regression equations of M-SAAS were as follows: ideal PI-LL=0.47×(age-55)+0.3, ideal PT=0.44×(age-55) +14 and ideal TPA=0.37×(age-55)+9. The final M-SAAS of ASD patients was 0.2±2.8(-5 to 5). Immediately after surgery, 17 patients(25.0%) were evaluated as "Under-corrected", 31 patients(45.6%) as "Matched", and 20 patients(29.4%) as "Over-corrected". The incidence of postoperative PJK/PJF was 11.8%(2/17), 6.5%(2/31) and 40.0%(8/20), respectively. The incidence of PJK/PJF in the "Over-correction" group was higher than that in the "Matched" group with statistical significance(P=0.008). Conclusions: SAAS is not suitable for the prediction of postoperative PJK/PJF in Chinese ASD patients. M-SAAS modified according to the age-matched spinal-pelvic sequence parameter relationship in middle-aged and elderly Chinese can predict the incidence of postoperative PJK/PJF in ASD patients.