一项多中心研究显示，老年颈椎骨折患者行脊柱融合手术后 1 年的死亡率和行走能力。
A multicenter study of 1-year mortality and walking capacity after spinal fusion surgery for cervical fracture in elderly patients.
机构信息
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
Department of Orthopaedic Surgery, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama, Toyama, 930-8550, Japan.
出版信息
BMC Musculoskelet Disord. 2022 Aug 20;23(1):798. doi: 10.1186/s12891-022-05752-5.
BACKGROUND
The 1-year mortality and functional prognoses of patients who received surgery for cervical trauma in the elderly remains unclear. The aim of this study is to investigate the rates of, and factors associated with mortality and the deterioration in walking capacity occurring 1 year after spinal fusion surgery for cervical fractures in patients 65 years of age or older.
METHODS
Three hundred thirteen patients aged 65 years or more with a traumatic cervical fracture who received spinal fusion surgery were enrolled. The patients were divided into a survival group and a mortality group, or a maintained walking capacity group and a deteriorated walking capacity group. We compared patients' backgrounds, trauma, and surgical parameters between the two groups. To identify factors associated with mortality or a deteriorated walking capacity 1 year postoperatively, a multivariate logistic regression analysis was conducted.
RESULTS
One year postoperatively, the rate of mortality was 8%. A higher Charlson comorbidity index (CCI) score, a more severe the American Spinal Cord Injury Association impairment scale (AIS), and longer surgical time were identified as independent factors associated with an increase in 1-year mortality. The rate of deterioration in walking capacity between pre-trauma and 1 year postoperatively was 33%. A more severe AIS, lower albumin (Alb) and hemoglobin (Hb) values, and a larger number of fused segments were identified as independent factors associated with the increased risk of deteriorated walking capacity 1 year postoperatively.
CONCLUSIONS
The 1-year rate of mortality after spinal fusion surgery for cervical fracture in patients 65 years of age or older was 8%, and its associated factors were a higher CCI score, a more severe AIS, and a longer surgical time. The rate of deterioration in walking capacity was 33%, and its associated factors were a more severe AIS, lower Alb, lower Hb values, and a larger number of fused segments.
背景
接受老年颈椎创伤手术的患者的 1 年死亡率和功能预后尚不清楚。本研究旨在探讨 65 岁及以上颈椎骨折患者接受脊柱融合手术后 1 年的死亡率和步行能力恶化的发生率及相关因素。
方法
纳入了 313 名 65 岁及以上因创伤性颈椎骨折接受脊柱融合手术的患者。将患者分为存活组和死亡组，或维持步行能力组和步行能力恶化组。我们比较了两组患者的背景、创伤和手术参数。为了确定与术后 1 年死亡率或步行能力恶化相关的因素，进行了多变量逻辑回归分析。
结果
术后 1 年，死亡率为 8%。较高的 Charlson 合并症指数（CCI）评分、更严重的美国脊髓损伤协会损伤量表（AIS）和更长的手术时间被确定为与 1 年死亡率增加相关的独立因素。与术前相比，术后 1 年步行能力恶化的发生率为 33%。更严重的 AIS、较低的白蛋白（Alb）和血红蛋白（Hb）值以及融合节段数量较多被确定为术后 1 年步行能力恶化风险增加的独立因素。
结论
65 岁及以上颈椎骨折患者脊柱融合术后 1 年的死亡率为 8%，其相关因素为 CCI 评分较高、AIS 较严重和手术时间较长。步行能力恶化的发生率为 33%，其相关因素为 AIS 更严重、Alb 更低、Hb 更低值和融合节段数量较多。
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