Torakolomber patlama kırıklarında ameliyat sonrası deformite için kestirimci faktörler: İstatistiksel yaklaşım

Öz

Amaç: Bu çalışmanın amacı istatistiksel analiz kullanarak patlama kırıklarının cerrahi tedavisinin son neticesinin ne derece operasyon şekli, kırık seviyesi ve birincil deformite şiddetine bağlı olduğunu değerlendirmekti.

Çalışma planı: Yalın ve çoklu doğrusal regresyon modelleri kullanılarak tek-omur-seviyeli torasik ve lombar omur kırıkları olan 287 hastanın verileri analiz edildi. Bağımlı değişken son takipteki (ST) kifotik açıydı ve kestirimci değişkenler ise operasyon şekli (anteriyor yaklaşım [AY], posteriyor kısa-segment fiksasyon [PKSF] ve posteriyor tek-segment fiksasyon [PTF]), kırık seviyesi (T11–L1, L2–L3 ve L4–L5) ve ameliyat öncesi kifotik açıydı. Modeller, ya bütün örnekleme ya da operasyon şekli alt gruplarına uygulandı.

Bulgular: Son takip kifotik açı varyasyonunda kırık seviyesi, yalın doğrusal regresyon analiz modellerinde AY ve PTF alt gruplarında sırasıyla %32’si ve %18’inin nedenini açıkladı. Son takip kifotik açıda varyasyonunda kırık seviyesi, aynı alt grupların çoklu doğrusal regresyon modellerinde %40’a kadarını açıkladı. Kestirimci değişken olarak cerrahi tedavi, PKSF ile tespit edilen hastaların AY ile tespit edilen hastalara oranla operasyon sonrası 8.51° daha şiddetli kifotik açı geliştirdiklerini belirtti. Ancak, model son takipteki kifotik açı varyasyonunun yalnızca %2’sine açıklama getirdi. Bağımsız değişken olarak ameliyat öncesi kifotik açının temel alındığı her alt gruba uygulanan yalın doğrusal regresyonlar değişkenin son takipteki kifotik açının %15’ini (PKSF alt grubu), %17’sini (AY alt grubu) ve %34’ünü (PTF alt grubu) açıkladığını ortaya koydu.

Çıkarımlar: Geçerli bütün regresyon modelleri fazla açıklayıcı değillerdi ve göz önünde bulundurulan bu faktörler dışında başka faktörlerinde dâhil olduğunu ileri sürdü.

Anahtar Kelimeler

• Post-travmatik kifotik deformite; torakolomber patlama kırığı.

Predictive factors for postoperative deformity in thoracolumbar burst fractures: a statistical approach

Öz

Objective: To assess, using statistical analysis, if and to what extent the final outcome of surgical treatment for burst fractures depends on operation type, fracture level and initial deformity severity.

Methods: A database of 287 patients with single-vertebral-level thoracic and lumbar spine fractures analysed using simple and multiple linear regression analyses models. The dependent variable was last follow-up (LFU) kyphotic angle and the predictor variables were operation type [anterior approach (AA), posterior short-segment fixation (PSSF) and posterior monosegmental fixation (PMF)], fracture level (T11–L1, L2–L3 and L4–L5) and preoperative kyphotic angle. The models were applied on either the whole sample or on the operation type subgroups.

Results: In simple linear regression analysis models, fracture level accounted for 32% and 18% of the variation in LFU kyphotic angle in the AA and PMF subgroups, respectively. In the multiple linear regression models for the same subgroups, up to 40% of the variation in LFU kyphotic angle was accounted for by fracture level. Surgical treatment, as predictor variable, indicated that patients reated by PSSF developed a post-surgical kyphotic angle 8.51° more severe than those treated by AA. However, the model accounted for only 2% of the variation in LFU kyphotic angle. Simple linear regressions performed on each subgroup with preoperative kyphotic angle as the independent variable revealed that the variable accounted for 15% (PSSF subgroup), 17% (AA subgroup) and 34% (PMF subgroup) of the variation in LFU kyphotic angle.

Conclusion: All valid regression models displayed modest explanatory power, suggesting that factors other than those taken into consideration are involved.

Anahtar Kelimeler

• Post-traumatic kyphotic deformity
• thoracolumbar
• burst fracture

Kaynakça

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