Watanabe Kei, Katsumi Keiichi, Ohashi Masayuki, Shibuya Yohei, Izumi Tomohiro, Hirano Toru, Endo Naoto, Kaito Takashi, Yamashita Tomoya, Fujiwara Hiroyasu, Nagamoto Yukitaka, Matsuoka Yuji, Suzuki Hidekazu, Nishimura Hirosuke, Terai Hidetomi, Tamai Koji, Tagami Atsushi, Yamada Syuta, Adachi Shinji, Yoshii Toshitaka, Ushio Shuta, Harimaya Katsumi, Kawaguchi Kenichi, Yokoyama Nobuhiko, Oishi Hidekazu, Doi Toshiro, Kimura Atsushi, Inoue Hirokazu, Inoue Gen, Miyagi Masayuki, Saito Wataru, Nakano Atsushi, Sakai Daisuke, Nukaga Tadashi, Ikegami Shota, Shimizu Masayuki, Futatsugi Toshimasa, Ohtori Seiji, Furuya Takeo, Orita Sumihisa, Imagama Shiro, Ando Kei, Kobayashi Kazuyoshi, Kiyasu Katsuhito, Murakami Hideki, Yoshioka Katsuhito, Seki Shoji, Hongo Michio, Kakutani Kenichiro, Yurube Takashi, Aoki Yasuchika, Oshima Masashi, Takahata Masahiko, Iwata Akira, Endo Hirooki, Abe Tetsuya, Tsukanishi Toshinori, Nakanishi Kazuyoshi, Watanabe Kota, Hikata Tomohiro, Suzuki Satoshi, Isogai Norihiro, Okada Eijiro, Funao Haruki, Ueda Seiji, Shiono Yuta, Nojiri Kenya, Hosogane Naobumi, Ishii Ken
Department of Orthopedic Surgery, Niigata University Medical and Dental General Hospital, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
Department of Orthopaedic Surgery, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan.
BMC Musculoskelet Disord. 2019 Mar 9;20(1):103. doi: 10.1186/s12891-019-2473-8.
To date, there have been little published data on surgical outcomes for patients with PD with thoracolumbar OVF. We conducted a retrospective multicenter study of registry data to investigate the outcomes of fusion surgery for patients with Parkinson's disease (PD) with osteoporotic vertebral fracture (OVF) in the thoracolumbar junction.
Retrospectively registered data were collected from 27 universities and their affiliated hospitals in Japan. In total, 26 patients with PD (mean age, 76 years; 3 men and 23 women) with thoracolumbar OVF who underwent spinal fusion with a minimum of 2 years of follow-up were included (PD group). Surgical invasion, perioperative complications, radiographic sagittal alignment, mechanical failure (MF) related to instrumentation, and clinical outcomes were evaluated. A control group of 296 non-PD patients (non-PD group) matched for age, sex, distribution of surgical procedures, number of fused segments, and follow-up period were used for comparison.
The PD group showed higher rates of perioperative complications (p < 0.01) and frequency of delirium than the non-PD group (p < 0.01). There were no significant differences in the degree of kyphosis correction, frequency of MF, visual analog scale of the symptoms, and improvement according to the Japanese Orthopaedic Association scoring system between the two groups. However, the PD group showed a higher proportion of non-ambulators and dependent ambulators with walkers at the final follow-up (p < 0.01).
A similar surgical strategy can be applicable to patients with PD with OVF in the thoracolumbar junction. However, physicians should pay extra attention to intensive perioperative care to prevent various adverse events and implement a rehabilitation regimen to regain walking ability.
迄今为止，关于帕金森病（PD）合并胸腰椎骨质疏松性椎体骨折（OVF）患者的手术疗效，发表的数据很少。我们进行了一项基于登记数据的回顾性多中心研究，以调查胸腰段合并骨质疏松性椎体骨折的帕金森病患者的融合手术疗效。
回顾性收集日本27所大学及其附属医院登记的数据。总共纳入26例胸腰椎骨质疏松性椎体骨折的帕金森病患者（平均年龄76岁；男性3例，女性23例），这些患者接受了脊柱融合术，且随访时间至少2年（PD组）。评估手术创伤、围手术期并发症、影像学矢状面排列、与内固定相关的机械性失败（MF）以及临床疗效。选取296例年龄、性别、手术方式分布、融合节段数和随访时间相匹配的非帕金森病患者作为对照组（非PD组）进行比较。
PD组围手术期并发症发生率（p<0.01）和谵妄发生率均高于非PD组（p<0.01）。两组在驼背矫正程度、MF发生率、症状视觉模拟量表评分以及根据日本骨科协会评分系统的改善情况方面均无显著差异。然而，在末次随访时，PD组非步行者和依赖助行器步行者的比例更高（p<0.01）。
类似的手术策略可应用于胸腰段合并OVF的PD患者。然而，医生应格外重视围手术期的强化护理，以预防各种不良事件，并实施康复方案以恢复步行能力。
