老年性脊柱后凸畸形的北京大学第一医院(PUFH)分型和治疗

目的 对老年性脊柱后凸畸形提出北京大学第一医院(PUFH)分型方法,并对分型进行临床验证.方法 回顾性分析北京大学第一医院2003年4月至2007年2月收入院,具有完整诊治记录及随访资料的242例老年性脊柱后凸畸形患者,男68例,女174例;年龄53～87岁.平均71.5岁.根据脊柱矢状位的平衡性、脊柱后凸畸形的部位进行分型,分析各亚型临床表现、影像学和治疗方法的特点.对分型的一致性和可重复性进行研究.于2007年3月至2008年3月,应用PUFH分型方法对80例老年性脊柱后凸畸形患者(男27例,女53例;年龄56～83岁,平均69.4岁)进行分型并指导临床诊疗.结果 将老年性脊柱后凸畸形患者分为4型(胸椎后凸畸形、胸腰段后凸畸形、腰椎后凸畸形和全脊柱后凸畸形)及8个亚型(每型分为平衡型和非平衡型),分析归纳相应的临床特点.两位观察者的一致性为87.5%,Kappa系数为0.859;可重复性为93.7%,Kappa系数为0.929.应用此分型指导治疗80例老年性脊柱后凸畸形患者.VAS评分:治疗前(7.7±1.4)分,末次随访(4.1±1.2)分;Prolo功能分级:治疗前(5.2±1.1)级,末次随访(8.4±1.0)级;后凸畸形有不同程度改善.结论 PUFH分型是一种针对老年性脊柱后凸畸形的分型方法,其直观、简洁、对治疗具有指导意义.

Peking University First Hospital (PUFH) classification and treatments for senile spinal kyphotic deformity

Objective To identify and classify the senile spinal kyphotie deformity according Peking University First Hospital (PUFH) classification system and carry out clinical study for confirmation. Methods The clinical data of 242 patients with senile spinal kyphotic deformity in PUFH from April 2003 to February 2007 was retrospectively analyzed. There were 68 males and 174 females, with the average age of 71.5 years. All patients were classified based on the sagittal balance of spine, the region of the kyphosis. The clinical characters, radiological manifestation, and treatments of all subtypes were analyzed. The consistency and repeatability were investigated. From March 2007 to March 2008, 80 patients (male 27 and female 53, average age 69.4 years) were classified according to this classification, guided clinical treatment and analyzed the results. Results This classification divided the senile spinal kyphotic deformity into 4 types(thoracic kyphosis, thoracolumbar kyphosis, lumbar kyphosis and total spinal kyphosis)and 8 subtypes (every type includes balance subtype and imbalance subtype) with pertinent clinical characters. The consistency of two observers was 87.5% and Kappa coefficient was 0.859, the repeatability was 93.7% and Kappa coefficient was 0.929. Guided by this classification, 80 patients were treated and got the good clinical results by the evaluation of VAS and Prolo scales, and also got the different degree of corrections of the kyphotic deformity. Conclusion PUFH classification is for senile spinal kyphotic deformity, and with the characters of vivacity, effectiveness and meaning for treatments. Rationality and validity of this classification need to be tested by further multi-center prospective studies.