Ohashi Masayuki, Hirano Toru, Watanabe Kei, Katsumi Keiichi, Shoji Hirokazu, Mizouchi Tatsuki, Endo Naoto
Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan.
Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata 951-8510, Japan.
Spine Deform. 2018 Mar-Apr;6(2):170-176. doi: 10.1016/j.jspd.2017.09.002. Epub 2017 Oct 16.
A retrospective, long-term follow-up study.
We investigated the incidence and risk factors for osteopenia at a minimum of 20 years after spinal instrumented fusion for adolescent idiopathic scoliosis (AIS).
Surgically treated AIS patients may be likely to have osteopenia in adulthood because the association between AIS and osteopenia has been well documented. However, the long-term results of AIS surgery on BMD have not been evaluated.
Twenty-one (19 women; mean age, 45.3 years) of 45 consecutive patients with AIS who underwent spinal instrumented fusion surgery between 1973 and 1994 consented to inclusion in the current analysis. Based on their T scores for bone mineral density (BMD) of the left hip, participants were divided into an osteopenia/osteoporosis group (group P, T score < -1.0) and a normal group (group N, T score ≥ -1.0). Z scores of the left hip were used for analyses of the association between bone mineral status and individual factors.
Eleven participants (52.4%) were categorized into group P. Mean body weight (kg) at survey (46.6 vs. 56.8) and mean body mass index (BMI) at both surgery (17.2 vs. 19.5) and survey (18.7 vs. 23.2) were significantly lower in group P than in group N (p < .05). Moreover, body weight at survey (Spearman rank correlation coefficient, r = 0.49), as well as BMI at both surgery (r = 0.67) and survey (r = 0.61) demonstrated positive correlations with the Z-score (p < .05).
More than half of the participants had osteopenia or osteoporosis, and both preoperative and postoperative low BMI were risk factors for osteopenia in adulthood.
Level IV.
一项回顾性长期随访研究。
我们调查了青少年特发性脊柱侧凸（AIS）行脊柱器械融合术后至少20年时骨质减少的发生率及危险因素。
由于AIS与骨质减少之间的关联已有充分记录，接受手术治疗的AIS患者成年后可能易患骨质减少。然而，AIS手术对骨密度的长期影响尚未得到评估。
1973年至1994年间连续接受脊柱器械融合手术的45例AIS患者中有21例（19名女性；平均年龄45.3岁）同意纳入本分析。根据左髋骨矿物质密度（BMD）的T值，参与者被分为骨质减少/骨质疏松组（P组，T值＜-1.0）和正常组（N组，T值≥-1.0）。左髋的Z值用于分析骨矿物质状态与个体因素之间的关联。
11名参与者（52.4%）被归入P组。P组调查时的平均体重（kg）（46.6对56.8）以及手术时（17.2对19.5）和调查时（18.7对23.2）的平均体重指数（BMI）均显著低于N组（p＜0.05）。此外，调查时的体重（斯皮尔曼等级相关系数，r = 0.49）以及手术时（r = 0.67）和调查时（r = 0.61）的BMI与Z值呈正相关（p＜0.05）。
超过一半的参与者患有骨质减少或骨质疏松，术前和术后低BMI都是成年后骨质减少的危险因素。
IV级。
