Arima Hideyuki, Yamato Yu, Hasegawa Tomohiko, Togawa Daisuke, Yoshida Go, Yasuda Tatsuya, Banno Tomohiro, Oe Shin, Ushirozako Hiroki, Yamada Tomohiro, Watanabe Yuh, Ide Koichiro, Matsuyama Yukihiro
1Department of Orthopaedic Surgery and.
2Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu; and.
J Neurosurg Spine. 2021 Jun 4;35(2):235-242. doi: 10.3171/2020.10.SPINE201323. Print 2021 Aug 1.
Extensive corrective fusion surgery was performed on elderly patients with adult spinal deformity (ASD) to improve abnormal posture. Varying improvements in postoperative walking function were expected owing to differences in muscular strength and bone quality between patients in their 40s and those over 75 years of age. The purpose of this study was to compare preoperative and postoperative gait posture and physical functionality in elderly patients with ASD who underwent extensive corrective fusion to the thoracic spine.
A prospectively maintained surgical database was reviewed for patients with ASD who underwent corrective fusion surgery (thoracic spine to pelvis) between 2011 and 2016. The cohort was divided into three age groups: nonelderly (40-64 years), young-old (65-74 years), and old-old (> 75 years). Patients underwent a 4-m walk test preoperatively and 2 years postoperatively to measure gait-trunk tilt angle and walking speed (meters per minute).
Among 291 patients with ASD who underwent corrective fusion surgery, 56 patients (14 men and 42 women; mean age 68.8 years) were included. Mean preoperative gait-trunk tilt angle (12.9° vs 5.2°, p < 0.01) and walking speed (41.2 m/min vs 45.7 m/min, p < 0.01) significantly improved postoperatively. Intergroup analysis revealed that the mean preoperative gait-trunk tilt angles in the nonelderly (n = 13), young-old (n = 28), and old-old (n = 15) groups were 11.9°, 10.0°, and 19.3°, respectively; postoperatively, these improved to 4.5°, 4.5°, and 7.2°, respectively. Mean preoperative walking speeds of 47.9, 40.0, and 37.7 m/min improved to 52.4, 44.8, and 41.5 m/min postoperatively in the nonelderly, young-old, and old-old groups, respectively. There were no statistically significant differences in degree of improvement in gait-trunk tilt angle and walking speed among groups.
Extensive corrective fusion surgery improved the postoperative walking posture of patients with ASD. Statistical analysis of gait measurements demonstrated intergroup equivalence, indicating comparable improvement in physical functionality in elderly and middle-aged patients after corrective fusion surgery.
对患有成人脊柱畸形（ASD）的老年患者进行广泛的矫正融合手术，以改善异常姿势。由于40多岁和75岁以上患者的肌肉力量和骨质存在差异，预计术后行走功能会有不同程度的改善。本研究的目的是比较接受广泛胸椎矫正融合术的老年ASD患者术前和术后的步态姿势及身体功能。
回顾了2011年至2016年间接受矫正融合手术（胸椎至骨盆）的ASD患者的前瞻性维护手术数据库。该队列分为三个年龄组：非老年组（40 - 64岁）、年轻老年组（65 - 74岁）和老年老年组（>75岁）。患者在术前和术后2年进行4米步行测试，以测量步态躯干倾斜角度和步行速度（米/分钟）。
在291例接受矫正融合手术的ASD患者中，纳入了56例患者（14例男性和42例女性；平均年龄68.8岁）。术后平均术前步态躯干倾斜角度（12.9°对5.2°，p < 0.01）和步行速度（41.2米/分钟对45.7米/分钟，p < 0.01）显著改善。组间分析显示，非老年组（n = 13）、年轻老年组（n = 28）和老年老年组（n = 15）的平均术前步态躯干倾斜角度分别为11.9°、10.0°和19.3°；术后分别改善至4.5°、4.5°和7.2°。非老年组、年轻老年组和老年老年组的术前平均步行速度分别为47.9、40.0和37.7米/分钟，术后分别提高至52.4、44.8和41.5米/分钟。各组之间步态躯干倾斜角度和步行速度的改善程度无统计学显著差异。
广泛的矫正融合手术改善了ASD患者术后的行走姿势。步态测量的统计分析表明组间等效，表明矫正融合手术后老年和中年患者的身体功能有可比的改善。
