中文摘要：

目的 探讨低龄先天性脊柱畸形儿童半椎体切除术后发生近端交界性后凸（PJK）的预后因素.方法 回顾性分析2009年1月至2014年6月在南京大学医学院附属鼓楼医院脊柱外科接受后路半椎体切除、有完整临床及影像学资料的136例先天性脊柱畸形患儿的临床资料,男性75例,女性61例;年龄3～10岁,平均（5.0±1.7）岁.术前、术后3个月及末次随访时测量脊柱骨盆参数、局部后凸角（SK）及近端交界角（PJA）.计数资料和计量资料的比较分别采用x2检验和t检验.结果 截至2016年6月,术后平均随访（32.8±10.3）个月（24～ 73个月）.19例患儿发生了PJK,其中15例于术后3个月内发生,最常见类型为Ⅰ型（后方韧带破坏）.PJK组患者术前TK＞40°（9/19）、融合节段＞4个（13/19）和SK矫正＞30°（9/19）的发生率均高于非PJK组（22.2％、37.6％、13.7％）（x2=7.259、6.375、12.368,P值均＜0.05）,而两组患者术前PJA、腰椎前凸角、最上端固定椎位置及SVA改变的差异均无统计学意义（P值均＞0.05）.PJK组术前PJA为7.5°±2.9°,术后3个月PJA为21.3°±4.3°,10例患儿接受支具治疗,至末次随访时PJA为20.6°±3.7°,未见后凸进行性加重.结论 低龄儿童半椎体切除术后PJK可能主要发生于术后3个月内;术前后凸畸形、后凸过度矫正及后方韧带损伤是其预后因素.

英文摘要：

Objective To investigate the risk factors of proximal junctional kyphosis （PJK） in young children who underwent posterior hemivertebra resection and instrumented fusion.Methods This study reviewed the charts and radiographs of 136 consecutive young children with congenital scoliosis who underwent posterior hemivertebra resection and instrumented fusion in Department of Orthopaedics,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School from January 2009 to June 2014,including 75 males and 61 females,with an average age of （5.0± 1.7） years（3-10 years）.Proximal junctional angle（PJA）,spino-pelvic parameters and segmental kyphosis （SK） were recorded pre-and post-operation and at last follow-up.The changes of PJA and radiographic features of proximal junction were also observed.x2 test and t-test were used to analyzed enumeration data and measurement data,respectively.Results The average follow-up period was （32.8± 10.3）months （ranging from 24 to 73 months） by June 2016.Among these patients,PJK occurred in 19 cases.Fifteen patients developed PJK during the first 3 months after surgery.The most common type of PJK was ligamentous failure.Compared with the non-PJK group （22.2%,37.6%,13.7%）,the PJK group showed higher rate of preoperative TK〉40° （9/19）,fusion levels 〉4 （13/19） and greater SK change 〉 30° （9/19） （x2 =7.259,6.375,12.368;all P〈 0.05）,while there were no difference between the two groups in terms of preoperative PJA,lumbar lordosis,SVA and upper instrument vertebra location （all P〉0.05）.The average PJA increased from 7.5° ±2.9° to 21.3° ±4.3° at 3 months after surgery to 20.6°±3.7° at the final follow-up visit in the PJK group.At the time of the final follow-up visit,ten patients received brace treatment,with no significant progression of PJA.Conclusions PJK might mainly occurs within 3 months postoperatively.Its prognostic factors include preoperative hyperkyphosis,over correction of kyphosis and liga