作　　者： (王涛）; (刘丰雨）; (杨思东）; (王辉）; (魏海醌）; (丁文元）;

机构地区： 河北医科大学第三医院脊柱外科,石家庄050051

出　　处： 《中华解剖与临床杂志》 2017年第4期301-305,共5页

摘　　要： 目的 探讨影像学参数与近端交界性后凸（PJK）畸形的关系.方法 在PubMed、CNKI和万方数据库以＂risk factor＂＂proximal junctional kyphosis＂和＂危险因素＂＂近端交界性后凸畸形＂为关鍵词检索2015年5月之前的文献.提取的数据主要有融合到S1、术前T5-12胸椎后凸角〉40°、C7椎体偏移距离（SVA）≥5cm,并进行Meta分析,在固定效应模型下,用优势比（OR）衡量影像学参数.结果 经筛选,共10篇文献入选本研究,共纳入患者1851例,术后551例发生PJK,发生率为29.8%.融合到S1、术前SVA≥5cm、术前T5-12胸椎后凸角〉40°与发生PJK的各研究间均无明显异质性（I2=0、19%、0,P值均〉0.10）,均选用固定效应模型进行分析.Meta分析结果显示,融合到S1的患者术后更易发生PJK（OR=2.12,95%CI1.57-2.87;Z=4.87,P〈0.01）;术前SVA≥5cm的患者术后更易发生PJK（OR=2.53,95%CI1.24-5.18;Z=2.55,P=0.01）;术前T5-12胸椎后凸角〉40°的患者术后更易发生PJK（OR=2.86,95%CI1.73-4.13;Z=4.44,P〈0.01）.结论 PJK的发生是多因素共同作用的结果,现有的数据提示融合到S1、术前T5-12胸椎后凸角〉40°和术前SVA≥5cm是PJK发生的危险因素. Objective To analyse association between radiographic parameters and proximal junctional kyphosis（PJK） in clinic.Methods An extensive search of literature was performed in PubMed, CNKI database and Wan Fang database （up to May 2015）, ＂risk factor＂ ＂proximal junctional kyphosis＂ as key words.The following risk factors were extracted： fusion to S1, preoperative hyperkyphotic thoracic alignment（T5-12）〉40°, and preoperatively SVA difference≥5 cm.Data analysis was conducted with Review Manager 5.3 and we used odds ratio （OR） to assess statistics under Fixed-effect model.Results Total 10 articles were included in this study, including 1 851 patients.Among them, 551 patients suffered from PJK after surgery.The incidence of PJK after surgery was 29.8%.There was no significant heterogeneity in fusion to S1, preoperatively SVA≥5 cm, preoperatively T5-12〉40°（I2=0, 19%, 0, all P values〉0.10）, so we selected fixed-effect model to analyze.The analysis implied that patients with fusion to S1 （OR=2.12, 95%CI 1.57-2.87, Z=4.87, P〈0.01）, preoperatively T5-12〉40°（OR=2.86, 95%CI 1.73-4.13, Z=4.44, P〈0.01） and preoperatively SVA difference≥5 cm（OR=2.53, 95%CI 1.24-5.18, Z=2.55, P=0.01） were more likely to have PJK post-surgery.Conclusions The existing data show： fusion to S1, preoperatively T5-12〉40°, preoperatively SVA difference≥5 cm are closely related with incidence of PJK.

关 键 词： 脊柱融合术 副作用 近端交界性后凸 危险因素 影像学参数 分析