影响骨质疏松性椎体骨折骨不连患者术后死亡率的因素及术前血清白蛋白对死亡率的影响。
Factors affecting postoperative mortality of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality.
作者信息
Ohba Tetsuro, Yokomichi Hiroshi, Koyama Kensuke, Tanaka Nobuki, Oda Kotaro, Haro Hirotaka
机构信息
Department of Orthopaedic Surgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan.
Department of Health Sciences, University of Yamanashi, Yamanashi, Japan.
出版信息
BMC Musculoskelet Disord. 2020 Aug 10;21(1):528. doi: 10.1186/s12891-020-03564-z.
ABTSRACT
BACKGROUND: Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. Our aim was to evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine postoperative mortality.
METHODS
We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Mortality was estimated using the Kaplan-Meier method and a log-rank test. The preoperative backgrounds of patients were analyzed to determine which risk factors led to death among the OVF cases. Kaplan-Meier curves were used to estimate survival based on preoperative albumin levels of ≤3.5 g/dL (hypoalbuminemia) versus > 3.5 mg/dL.
RESULTS
The mean follow-up time was 4.1 ± 0.8 years. Two years after surgery, percentage of patients who had died was 15%. The VAS scores and modified Frankel classification were significantly improved one year after surgery. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. The univariate analysis showed that male gender, serum albumin < 3.5 g/dl, creatinine clearance< 60 mg/dl, and the American Society of Anesthesiologists classificat0ion ≥3 were significant risk factors for postoperative mortality. Multivariate analysis revealed that only serum albumin ≤3.5 g/dL was a significant risk factor for long-term postoperative mortality of patients with OVF.
CONCLUSIONS
Preoperative hypoalbuminemia was associated with postoperative mortality following surgery for OVF.
LEVEL OF EVIDENCE
Level 3.
摘要
背景：众多手术方法的比较研究聚焦于临床和影像学结果，以及骨脆性对脊柱手术结果的影响；然而，关于死亡率或发病率风险的见解有限。此外，手术治疗对椎体压缩性骨折后生存率的影响仍存在争议。我们的目的是评估影响因骨质疏松性椎体骨折（OVF）骨不连而接受脊柱手术患者长期生存的术前因素，并确定术后死亡率。
方法
我们回顾性分析了105例连续因OVF接受脊柱手术患者的病例。使用Kaplan-Meier方法和对数秩检验估计死亡率。分析患者的术前背景，以确定哪些危险因素导致OVF病例死亡。基于术前白蛋白水平≤3.5 g/dL（低白蛋白血症）与>3.5 mg/dL，使用Kaplan-Meier曲线估计生存率。
结果
平均随访时间为4.1±0.8年。术后两年，死亡患者的比例为15%。术后一年，视觉模拟评分（VAS）和改良Frankel分级显著改善。死亡的OVF患者中男性与女性的比例显著高于仍存活的患者。OVF手术方法之间在死亡率方面未观察到显著差异。单因素分析表明，男性、血清白蛋白<3.5 g/dl、肌酐清除率<60 mg/dl以及美国麻醉医师协会分级≥3是术后死亡的显著危险因素。多因素分析显示，仅血清白蛋白≤3.5 g/dL是OVF患者术后长期死亡的显著危险因素。
结论
术前低白蛋白血症与OVF手术后的术后死亡率相关。
证据级别
3级。
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