脊柱畸形手术中骨质量的术前评估：与临床实践和已发表建议的相关性。
Preoperative Assessment of Bone Quality in Spine Deformity Surgery: Correlation With Clinical Practice and Published Recommendations.
机构信息
Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY.
出版信息
Spine (Phila Pa 1976). 2019 Jun 15;44(12):E735-E741. doi: 10.1097/BRS.0000000000002956.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
The goals of this study were to (A) evaluate preoperative bone quality assessment and intervention practice over time and (B) review the current evidence for bone evaluation in spine fusion surgery.
SUMMARY OF BACKGROUND DATA
Deformity spine surgery has demonstrated improved quality of life in patients; however, its cost has made it controversial. If preoperative bone quality can be optimized then potentially these treatments could be more durable; however, at present, no clinical practice guidelines have been published by professional spine surgical organizations.
METHODS
A retrospective cohort review was performed on patients who underwent a minimum five-level primary or revision fusion. Preoperative bone quality metrics were evaluated over time from 2012 to 2017 to find potential trends. Subgroup analysis was conducted based on age, sex, preoperative diagnosis, and spine fusion region.
RESULTS
Patient characteristics including preoperative rates of pseudarthrosis and junctional failure did not change. An increasing trend of physician bone health documentation was noted (P = 0.045) but changes in other metrics were not significant. A sex bias favored females who had higher rates of preoperative DXA studies (P = 0.001), Vitamin D 25-OH serum labs (P = 0.005), Vitamin D supplementation (P = 0.022), calcium supplementation (P < 0.001), antiresorptive therapy (P = 0.016), and surgeon clinical documentation of bone health (P = 0.008) compared with men.
CONCLUSION
Our spine surgeons have increased documentation of bone health discussions but this has not affected bone quality interventions. A discrepancy exists favoring females over males in nearly all preoperative bone quality assessment metrics. Preoperative vitamin D level and BMD assessment should be considered in patients undergoing long fusion constructs; however, the data for bone anabolic and resorptive agents have less support. Clinical practice guidelines on preoperative bone quality assessment spine patients should be defined.
LEVEL OF EVIDENCE
研究设计
回顾性队列研究。
目的
本研究的目的是（A）评估随时间推移的术前骨质量评估和干预实践，以及（B）回顾脊柱融合手术中骨评估的当前证据。
背景数据概要
脊柱畸形手术已证明可改善患者的生活质量；然而，其成本使其备受争议。如果可以优化术前骨质量，那么这些治疗方法可能会更持久；但是，目前，专业脊柱外科组织尚未发布临床实践指南。
方法
对 2012 年至 2017 年期间接受至少 5 个节段原发或翻修融合术的患者进行回顾性队列研究。随时间评估术前骨质量指标，以寻找潜在趋势。根据年龄、性别、术前诊断和脊柱融合区域进行亚组分析。
结果
患者特征包括术前假关节和交界性失败的发生率没有变化。注意到医生骨健康记录的增加趋势（P=0.045），但其他指标的变化不显著。性别偏见有利于女性，她们接受术前 DXA 研究（P=0.001）、25-羟维生素 D 血清检查（P=0.005）、维生素 D 补充剂（P=0.022）、钙补充剂（P<0.001）、抗吸收治疗（P=0.016）和外科医生骨健康临床记录（P=0.008）的比率更高。
结论
我们的脊柱外科医生增加了骨健康讨论的记录，但这并没有影响骨质量干预措施。在几乎所有术前骨质量评估指标中，女性都比男性更有优势。在接受长融合结构的患者中，应考虑术前维生素 D 水平和 BMD 评估；然而，骨合成和吸收剂的数据支持较少。应制定脊柱患者术前骨质量评估的临床实践指南。
证据等级
4。
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