Deyo Richard A, Gray Darryl T, Kreuter William, Mirza Sohail, Martin Brook I
Department of Medicine, University of Washington, Seattle, Washington, USA.
Spine (Phila Pa 1976). 2005 Jun 15;30(12):1441-5; discussion 1446-7. doi: 10.1097/01.brs.0000166503.37969.8a.
Retrospective cohort study using national sample administrative data.
To determine if lumbar fusion rates increased in the 1990s and to compare lumbar fusion rates with those of other major musculoskeletal procedures.
Previous studies found that lumbar fusion rates rose more rapidly during the 1980s than did other types of lumbar surgery.
We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 1988 through 2001 to examine trends. U.S. Census data were used for calculating age and sex-adjusted population-based rates. We excluded patients with vertebral fractures, cancer, or infection.
In 2001, over 122,000 lumbar fusions were performed nationwide for degenerative conditions. This represented a 220% increase from 1990 in fusions per 100,000. The increase accelerated after 1996, when fusion cages were approved. From 1996 to 2001, the number of lumbar fusions increased 113%, compared with 13 to 15% for hip replacement and knee arthroplasty. Rates of lumbar fusion rose most rapidly among patients aged 60 and above. The proportion of lumbar operations involving a fusion increased for all diagnoses.
Lumbar fusion rates rose even more rapidly in the 90s than in the 80s. The most rapid increases followed the approval of new surgical implants and were much greater than increases in other major orthopedic procedures. The most rapid increases in fusion rates were among adults aged 60 and above. These increases were not associated with reports of clarified indications or improved efficacy, suggesting a need for better data on the efficacy of various fusion techniques for various indications.
使用全国样本行政数据的回顾性队列研究。
确定20世纪90年代腰椎融合率是否上升，并将腰椎融合率与其他主要肌肉骨骼手术的融合率进行比较。
先前的研究发现，20世纪80年代腰椎融合率的上升速度比其他类型的腰椎手术更快。
我们使用了1988年至2001年的医疗保健成本和利用项目全国住院患者样本进行趋势研究。美国人口普查数据用于计算年龄和性别调整后的基于人群的比率。我们排除了患有椎体骨折、癌症或感染的患者。
2001年，全国范围内因退行性疾病进行了超过122,000例腰椎融合手术。这意味着每10万人中的融合手术数量比1990年增加了220%。1996年融合器获批后，增长加速。从1996年到2001年，腰椎融合手术的数量增加了113%，而髋关节置换和膝关节置换手术的增加幅度为13%至15%。60岁及以上患者的腰椎融合率上升最为迅速。所有诊断中涉及融合的腰椎手术比例均有所增加。
20世纪90年代腰椎融合率的上升速度比80年代更快。增长最快的时期是在新手术植入物获批之后，且远高于其他主要骨科手术的增长率。融合率上升最快的是60岁及以上的成年人。这些增长与明确适应症或疗效改善的报告无关，这表明需要更好的数据来了解各种融合技术针对各种适应症的疗效。
