| ObjectiveThe thoracolumbar segment of the spine is the articulation of the thoracic and lumbar vertebrae,which takes over the more mobile lumbar vertebrae and the slightly less mobile thoracic vertebrae,and is a site where spinal fractures are likely to occur.Patients treated conservatively have difficulty recovering the height of the fractured vertebrae and often develop localized kyphosis.Severe kyphosis can lead to spinal instability and sagittal imbalance,causing local pain,deformity and neurological dysfunction and seriously affecting the patient’s quality of life.Posterior osteotomy with long-segment fusion and internal fixation is an effective means to cure OTFK,which correct kyphosis and reestablishing sagittal balance.However,there are various postoperative complications such as nerve injury,failure of internal fixation and proximal junctional kyphosis(PJK).PJK affects patients’ quality of life after surgery,and such patients may face poor clinical prognosis such as pain,instability of internal fixation,and limitation of movement,and some may even require revision surgery.Therefore,it is crucial to investigate the risk factors for the occurrence of PJK and make preventive countermeasures.The aim of this study was to investigate and analyze the risk factors for the occurrence of proximal junctional kyphosis and quality of life in patients with old thoracolumbar fracture kyphosis after orthopaedic surgery.MethodsFrom January 2017 to August 2020,41 patients with old thoracolumbar fracture with kyphosis of Fuyang People’s Hospital were retrospectively analyzed,including 7males and 34 females,who underwent posterior osteotomy and long segment fusion and orthopedic surgery with complete clinical and imaging data.The age range is from 45 to77 years old,with an average age of(62.2 ±9.5)years.The body mass index(BMI),fusion segment and the position of the upper instrumented vertebra(UIV)were recorded,and the quality of life of the patients was evaluated by the International Society for Scoliosis Research scale(SRS-22).The proximal junctional angle(PJA),pelvic incidence(PI),pelvic tilt(PT),sacral slope(SS),sagittal vertical axis(SVA),thoracic kyphosis(TK),lumbar lordosis(LL)and local kyphosis cobb angle(LKCA),spinal flexibility(SF)were measured pre-and post-operationally and at last follow-up.According to the occurrence of PJK after operation,the patients were divided into PJK group and non-PJK group.The data of PJK group and non-PJK group were compared by independent sample t-test,χ2 test or Fisher exact probability method.Results41 patients were followed up for 28.2 ±13.3 months,during which PJK occured in9 cases(22.0%).5 cases occurred within 6 months after operation.In PJK group,the PJA was 3.7 °±4.0° before operation,12.3° ±5.9° 6 months after operation,and 18.9°±6.2° at the last follow-up.There was no significant difference in age,sex,follow-up time,BMI,fusion segment and UIV position between PJK group and non-PJK group.There were significant differences in PJA,TK and preoperative LKCA between the two groups at 6 months after operation and at the last follow-up,while there was no significant difference in other imaging data(P > 0.05).The results of logistic regression analysis showed that excessive LKCA correction(>35 °)was a risk factor for the occurrence of PJK.At the last follow-up,there was no significant difference in SRS-22 score between the two groups(P>0.05).ConclusionThe incidence of proximal junctional kyphosis after orthopedic correction of old thoracolumbar fracture with kyphosis was 22.0%.Excessive correction of local kyphosis cobb angle is a risk factor for PJK.There was no significant difference in life quality between PJK patients and non-PJK patients. |
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