Abstract：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.
王涛, 刘丰雨, 杨思东, 王辉, 魏海醌, 丁文元. 影像学参数与近端交界性后凸相关性的Meta分析[J]. 中华解剖与临床杂志, 2017, 22(4): 301-305.
Wang Tao, Liu Fengyu, Yang Sidong, Wang Hui, Wei Haikun, Ding Wenyuan.. The association between radiographic parameter and proximal junctional kyphosis: a Meta-analysis. Chinese Journal of Anatomy and Clinics, 2017, 22(4): 301-305.
Cammarata M, Aubin C, Wang X, et al. Biomechanical risk factors for proximal junctional kyphosis: a detailed numerical analysis of surgical instrumentation variables[J]. Spine(Phila Pa 1976), 2014, 39(8): E500-E507. DOI:10.1097/BRS.0000000000000222.
[2]
Cammarata M, Wang X, Mac-Thiong JM, et al. Biomechanical analysis of proximal junctional kyphosis: preliminary results[J]. Stud Health Technol Inform, 2012, 176: 299-302. DOI: 10.3233/978-1-61499-067-3-299.
[3]
Ha Y, Maruo K, Racine L, et al. Proximal junctional kyphosis and clinical outcomes in adult spinal deformity surgery with fusion from the thoracic spine to the sacrum: a comparison of proximal and distal upper instrumented vertebrae[J]. J Neurosurg Spine, 2013, 19(3): 360-369. DOI:10.3171/2013.5.SPINE12737.
[4]
Hart RA, McCarthy I, Ames CP, et al. Proximal junctional kyphosis and proximal junctional failure[J]. Neurosurg Clin N Am, 2013, 24(2): 213-218. DOI:10.1016/j.nec.2013.01.001.
[5]
Helgeson MD, Shah SA, Newton PO, et al. Evaluation of proximal junctional kyphosis in adolescent idiopathic scoliosis following pedicle screw, hook, or hybrid instrumentation[J]. Spine(Phila Pa 1976), 2010, 35(2): 177-181. DOI:10.1097/BRS.0b013e3181c77f8c.
[6]
Kim HJ, Yagi M, Nyugen J, et al.Combined anterior-posterior surgery is the most important risk factor for developing proximal junctional kyphosis in idiopathic scoliosis[J].Clin Orthop Relat Res, 2012, 470(6): 1633-1639. DOI:10.1007/s11999-011-2179-1.
[7]
Kim HJ, Lenke LG, Shaffrey CI, et al. Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review[J]. Spine(Phila Pa 1976), 2012, 37(22 Suppl): S144-S164. DOI:10.1097/BRS.0b013e31826d611b.
[8]
Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adult spinal deformity after segmental posterior spinal instrumentation and fusion: minimum five-year follow-up[J]. Spine(Phila Pa 1976), 2008, 33(20): 2179-2184. DOI:10.1097/BRS.0b013e31817c0428.
[9]
Kim YJ, Bridwell KH, Lenke LG, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up[J]. Spine(Phila Pa 1976), 2005, 30(18): 2045-2050. DOI:10.1097/01.brs.0000179084.45839.ad.
[10]
Kim YJ, Lenke LG, Bridwell KH, et al. Proximal junctional kyphosis in adolescent idiopathic scoliosis after 3 different types of posterior segmental spinal instrumentation and fusions: incidence and risk factor analysis of 410 cases[J]. Spine(Phila Pa 1976), 2007, 32(24): 2731-2738. DOI:10.1097/BRS.0b013e31815a7ead.
[11]
Lee JH, Kim JU, Jang JS, et al. Analysis of the incidence and risk factors for the progression of proximal junctional kyphosis following surgical treatment for lumbar degenerative kyphosis: minimum 2-year follow-up[J]. Br J Neurosurg, 2014, 28(2): 252-258. DOI:10.3109/02688697.2013.835369.
[12]
Yagi M, King AB, Boachie-Adjei O. Incidence, risk factors, and natural course of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis. Minimum 5 years of follow-up[J]. Spine(Phila Pa 1976), 2012, 37(17): 1479-1489. DOI:10.1097/BRS.0b013e31824e4888.
[13]
Maruo K, Ha Y, Inoue S, et al. Predictive factors for proximal junctional kyphosis in long fusions to the sacrum in adult spinal deformity[J]. Spine(Phila Pa 1976), 2013, 38(23): E1469-E1476. DOI:10.1097/BRS.0b013e3182a51d43.
[14]
Wang J, Zhao Y, Shen B, et al. Risk factor analysis of proximal junctional kyphosis after posterior fusion in patients with idiopathic scoliosis[J]. Injury, 2010, 41(4): 415-420. DOI:10.1016/j.injury.2010.01.001.
[15]
Yagi M, Akilah KB, Boachie-Adjei O. Incidence, risk factors and classification of proximal junctional kyphosis: surgical outcomes review of adult idiopathic scoliosis[J].Spine(Phila Pa 1976), 2011, 36(1): E60-E68. DOI:10.1097/BRS.0b013e3181eeaee2.
[16]
Yang SH, Chen PQ. Proximal kyphosis after short posterior fusion for thoracolumbar scoliosis[J]. Clin Orthop Relat Res, 2003(411): 152-158. DOI:10.1097/01.blo.0000069885.72909.bb.
2017, Vol. 22 
