糖尿病的特征与腰椎手术后临床结局改善不良有关。
Characteristics of diabetes associated with poor improvements in clinical outcomes after lumbar spine surgery.
机构信息
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka 545–8585, Japan.
出版信息
Spine (Phila Pa 1976). 2013 Mar 15;38(6):516-22. doi: 10.1097/BRS.0b013e318273583a.
STUDY DESIGN
Retrospective review.
OBJECTIVE
Evaluation of the impact of diabetes on lumbar spine surgery.
SUMMARY OF BACKGROUND DATA
Characteristics of diabetes that increase the risk of postoperative complications and poor surgical outcomes after lumbar spine surgery remain unclear.
METHODS
The demographic and clinical data of diabetic and nondiabetic patients, 50 years or older, undergoing lumbar spine surgery were reviewed. Japanese Orthopaedic Association and visual analogue scale scores for low back pain, leg pain, and numbness were assessed as perioperative outcomes. Analysis of covariance was used for comparison of perioperative outcomes to adjust for differences between the groups, and a proportional odds model was used to compute the odds ratio of poor improvement in each outcome.
RESULTS
Forty-one patients with diabetes were compared with 124 patients without diabetes. Visual analogue scale scores of final low back pain was higher for patients with than without diabetes (29.3 vs. 17.9, P = 0.013). Complications were similar in patients with and without diabetes except for nonunion after fusion surgery (20% vs. 3%, P = 0.095). When stratified by surgical procedure, final low back pain was significantly higher for patients with diabetes who underwent fusion surgery (39.1 vs. 17.4, P = 0.001). Patients with glycosylated hemoglobin of 6.5% or more displayed a 2-fold increase only in the odds ratio (OR) of poor improvement of low back pain (OR = 2.37; 95% confidence interval [CI], 0.99-5.70). Patients having diabetes for 20 years or more were more likely to experience poor improvement of low back pain and leg numbness (OR = 4.95; 95% CI, 1.69-14.5 and OR = 2.80; 95% CI, 0.98-7.94, respectively). Insulin use was associated with an increased OR for poor improvement of leg numbness (OR = 4.49; 95% CI, 1.24-16.3).
CONCLUSION
Longstanding diabetes, poor glycemic control, and insulin use might be associated with poor postoperative improvement.
研究设计
回顾性研究。
目的
评估糖尿病对腰椎手术的影响。
背景资料概要
糖尿病的某些特征会增加腰椎手术后发生术后并发症和手术结果不佳的风险，但具体特征仍不明确。
方法
回顾性分析了年龄在 50 岁及以上、行腰椎手术的糖尿病和非糖尿病患者的人口统计学和临床资料。评估日本矫形协会（Japanese Orthopaedic Association）和视觉模拟评分（visual analogue scale）中腰痛、腿痛和麻木的评分，作为围手术期的结果。采用协方差分析比较围手术期结果，以调整组间差异，并采用比例优势模型计算每个结果改善不良的优势比。
结果
41 例糖尿病患者与 124 例非糖尿病患者进行比较。与非糖尿病患者相比，糖尿病患者的最终腰痛视觉模拟评分更高（29.3 比 17.9，P = 0.013）。除融合手术后的非融合（20%比 3%，P = 0.095）外，两组患者的并发症相似。按手术方式分层，融合手术患者的最终腰痛明显更高（39.1 比 17.4，P = 0.001）。糖化血红蛋白（glycosylated hemoglobin）水平为 6.5%或更高的患者，其腰痛改善不良的优势比（odds ratio，OR）仅增加 2 倍（OR = 2.37；95%置信区间 [confidence interval，CI]，0.99-5.70）。患有糖尿病 20 年或更长时间的患者更有可能出现腰痛和腿部麻木改善不良（OR = 4.95；95%CI，1.69-14.5 和 OR = 2.80；95%CI，0.98-7.94）。胰岛素的使用与腿部麻木改善不良的 OR 增加相关（OR = 4.49；95%CI，1.24-16.3）。
结论
长期糖尿病、血糖控制不佳和胰岛素的使用可能与术后改善不良相关。
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