Grand Rapids Medical Education Partners, 1000 Monroe Ave NW, Grand Rapids, MI 49503, USA.
J Orthop Surg Res. 2013 Jan 14;8:1. doi: 10.1186/1749-799X-8-1.
Retrospective cohort study of 1430 patients undergoing lumbar spinal fusion from 2002 - 2009.
The goal of this study was to compare and evaluate the number of complications requiring reoperation in elderly versus younger patients.
rhBMP-2 has been utilized off label for instrumented lumbar posterolateral fusions for many years. Many series have demonstrated predictable healing rates and reoperations. Varying complication rates in elderly patients have been reported.
All patients undergoing instrumented lumbar posterolateral fusion of ≤ 3 levels consenting to utilization of rhBMP-2 were retrospectively evaluated. Patient demographics, body mass index, comorbidities, number of levels, associated interbody fusion, and types of bone void filler were analyzed. The age of patients were divided into less than 65 and greater than or equal to 65 years. Complications related to the performed procedure were recorded.
After exclusions, 482 consecutive patients were evaluated with 42.1% males and 57.9% females. Average age was 62 years with 250 (51.9%) < 65 and 232 (48.1%) ≥ 65 years. Patients ≥ 65 years of age stayed longer (5.0 days) in the hospital than younger patients (4.5 days) (p=0.005).Complications requiring reoperation were: acute seroma formation requiring decompression 15/482, 3.1%, bone overgrowth 4/482, 0.8%, infection requiring debridement 11/482, 2.3%, and revision fusion for symptomatic nonunion 18/482, 3.7%. No significant differences in complications were diagnosed between the two age groups. Statistical differences were noted between the age groups for medical comorbidities and surgical procedures. Patients older than 65 years underwent longer fusions (2.1 versus 1.7 levels, p=0.001).
Despite being older and having more comorbidities, elderly patients have similar complication and reoperation rates compared to younger healthier patients undergoing instrumented lumbar decompression fusions with rhBMP-2.
回顾性队列研究，纳入 2002 年至 2009 年间接受腰椎融合术的 1430 例患者。
本研究旨在比较和评估老年患者与年轻患者中需要再次手术治疗的并发症数量。
rhBMP-2 多年来已被超适应证用于器械辅助的腰椎后路融合术。多项研究均显示出可预测的愈合率和再手术率。但也有报道称老年患者的并发症发生率存在差异。
回顾性评估所有接受≤3 个节段的器械辅助腰椎后路融合术并同意使用 rhBMP-2 的患者。分析患者的人口统计学资料、体重指数、合并症、节段数、联合前路融合术及骨填充物类型。将患者年龄分为<65 岁和≥65 岁。记录与手术相关的并发症。
排除后，482 例连续患者接受评估，其中男性占 42.1%，女性占 57.9%。平均年龄为 62 岁，其中 250 例（51.9%）<65 岁，232 例（48.1%）≥65 岁。年龄≥65 岁的患者住院时间更长（5.0 天），而年龄较轻的患者（4.5 天）（p=0.005）。需要再次手术治疗的并发症包括：15/482（3.1%）急性血清肿形成需要减压，4/482（0.8%）骨过度生长，11/482（2.3%）感染需要清创，18/482（3.7%）症状性非融合需要翻修融合术。两组患者的并发症无显著差异。两组患者在合并症和手术方式方面存在统计学差异。年龄>65 岁的患者融合节段更长（2.1 与 1.7 个节段，p=0.001）。
尽管年龄较大且合并症较多，但接受 rhBMP-2 辅助器械下腰椎减压融合术的老年患者与较年轻、健康的患者相比，其并发症和再手术率相似。
