比较私营保险患者人群中接受手术治疗的颈椎脊髓病的术后并发症和再次手术率。
Comparison of Postoperative Complications and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in the Privately Insured Patient Population.
机构信息
Departments of Orthopaedic Surgery.
Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
出版信息
Clin Spine Surg. 2021 Nov 1;34(9):E531-E536. doi: 10.1097/BSD.0000000000001216.
STUDY DESIGN
This was a large database study.
OBJECTIVE
The objective of this study was to compare the incidence of complications and reoperation rates between the most common surgical treatments for cervical spondylotic myelopathy (CSM): anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and fusion (Lamifusion).
SUMMARY OF BACKGROUND DATA
CSM is a major contributor to disability and reduced quality of life worldwide.
METHODS
Humana insurance database was queried for CSM diagnoses between 2007 and 2016. The initial population was divided based on the surgical treatment and matched for age, sex, and Charlson Comorbidity index. Specific postoperative complications or revisions were analyzed at individual time points. Pearson χ2 analysis with Yate continuity correction was used.
RESULTS
Lamifusion had significantly higher rates of wound infection/disruption than ACDF or ACCF (5.03%, 2.19%, 2.29%; P=0.0008, 0.002, respectively) as well as iatrogenic deformity (4.75%, 2.19%, 2.10%; P=0.0036, 0.0013). Lamifusion also had a significantly higher rate of shock and same-day transfusion than ACDF (4.75%, 2.01%, P=0.0005), circulatory complications (2.01%, <1%, P=0.0183), and C5 palsy (4.84%, 1.74%, P≤0.0001). Compared with ACDF, Lamifusion had higher rates of hardware complication (3.29%, 2.01%, P=0.0468), and revision surgery (8.23% 5.85%, P=0.0395). Lamifusion had significantly lower rates of dysphagia than either ACDF (3.93% vs. 6.58%, P=0.0089) or ACCF (3.93% vs. 8.59%, P<0.0001). When comparing ACCF to ACDF, ACCF had significantly higher rates of circulatory complications (2.38%, <1%, P=0.0053), shock/same-day transfusion (3.2%, 2.0%, P=0.59), C5 palsy (3.47%, 1.74%, P=0.0108), and revision surgery (9.51%, 5.85%, P=0.0086).
CONCLUSIONS
The data shows that posterior Lamifusion has higher overall rate of complications compared with ACDF or ACCF. Furthermore, when comparing the anterior approaches, ACDF was associated with lower rate of complication and revision. ACCF had the highest overall rate of revision surgery.
研究设计
这是一项大型数据库研究。
目的
本研究旨在比较治疗颈椎病脊髓病（CSM）最常见的手术方法（前路颈椎间盘切除术和融合术[ACDF]、前路颈椎椎体切除术和融合术[ACCF]和后路椎板切除术和融合术[Lamifusion]）的并发症发生率和再手术率。
背景资料概要
CSM 是全球导致残疾和生活质量下降的主要原因。
方法
2007 年至 2016 年，对 Humana 保险数据库中 CSM 诊断进行了查询。根据手术治疗方法将初始人群分为基础人群，并对年龄、性别和 Charlson 合并症指数进行匹配。在各个时间点分析特定的术后并发症或修正。使用 Pearson χ2 分析和 Yate 连续性校正。
结果
与 ACDF 或 ACCF 相比，Lamifusion 的伤口感染/破裂（5.03%、2.19%、2.29%；P=0.0008、0.002）和医源性畸形（4.75%、2.19%、2.10%；P=0.0036、0.0013）发生率显著更高。Lamifusion 还比 ACDF 有更高的发生率出现休克和当日输血（4.75%、2.01%，P=0.0005）、循环并发症（2.01%、<1%，P=0.0183）和 C5 瘫痪（4.84%、1.74%，P≤0.0001）。与 ACDF 相比，Lamifusion 有更高的硬件并发症（3.29%、2.01%，P=0.0468）和修正手术（8.23%、5.85%，P=0.0395）发生率。与 ACDF 相比，Lamifusion 吞咽困难的发生率显著更低（3.93%比 6.58%，P=0.0089）或 ACCF（3.93%比 8.59%，P<0.0001）。与 ACCF 相比，ACCF 的循环并发症（2.38%、<1%，P=0.0053）、休克/当日输血（3.2%、2.0%，P=0.59）、C5 瘫痪（3.47%、1.74%，P=0.0108）和修正手术（9.51%、5.85%，P=0.0086）发生率更高。
结论
数据显示，后路 Lamifusion 与 ACDF 或 ACCF 相比，总体并发症发生率更高。此外，在比较前路方法时，ACDF 与较低的并发症和修正率相关。ACCF 的总体修正手术率最高。
Zotero 插件