慢性肾脏病患者脊柱融合术后的手术结果和融合率：肾功能的影响。
Surgical Outcomes and Fusion Rate Following Spinal Fusion in Patients with Chronic Kidney Disease: Impact of Kidney Function.
机构信息
Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea.
Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, South Korea.
出版信息
World Neurosurg. 2022 Dec;168:e587-e594. doi: 10.1016/j.wneu.2022.09.068. Epub 2022 Sep 19.
OBJECTIVE
To evaluate surgical outcomes and fusion rate following spinal fusion surgery in patients with chronic kidney disease and assess the impact of kidney function.
METHODS
From March 2017 to February 2021, 54 consecutive adult patients with chronic kidney disease who underwent spinal fusion surgery were enrolled. According to the glomerular filtration rate (GFR) categories, 35 and 19 patients were classified into the non-end-stage renal disease (ESRD) group (GFR categories 3a-4; eGFR, 15-59 mL/min/1.73 m) and ESRD group (GFR category 5; eGFR, <15 mL/min/1.73 m), respectively.
RESULTS
Baseline characteristics did not differ between the groups. The lumbar and thoracolumbar spines were the most operated. The mean number of fused vertebrae (4.9 ± 2.3 vs. 4.1 ± 2.0, P = 0.122), operative time (228.4 ± 129.6 min vs. 160.5 ± 87.5 min, P = 0.113), and surgical bleeding (743.1 ± 630.5 mL vs. 539.5 ± 384.4 mL, P = 0.354) did not differ between the groups. However, occurrence rates of medical complications (25.7% vs. 52.6%, P = 0.048) and 3-month readmission (8.6% vs. 35.3%, P = 0.045) were significantly different between the groups. While the 3-month mortality (10.5% vs. 2.9%, P = 0.28) and pseudarthrosis rates (35.3% vs. 9.1%, P = 0.047) were higher in the ESRD group, the difference was not statistically significant for the former entity.
CONCLUSIONS
Surgeons should consider the possibility of high morbidity and pseudarthrosis associated with spine surgeries when operating on patients with ESRD.
目的
评估慢性肾脏病患者脊柱融合术后的手术结果和融合率，并评估肾功能的影响。
方法
2017 年 3 月至 2021 年 2 月，连续纳入 54 例接受脊柱融合手术的慢性肾脏病成年患者。根据肾小球滤过率（GFR）分类，35 例和 19 例患者分别被归类为非终末期肾病（ESRD）组（GFR 3a-4 期；eGFR，15-59 mL/min/1.73 m）和 ESRD 组（GFR 5 期；eGFR，<15 mL/min/1.73 m）。
结果
两组间基线特征无差异。腰椎和胸腰椎是最常被手术的部位。融合的平均椎体数（4.9±2.3 比 4.1±2.0，P=0.122）、手术时间（228.4±129.6 分钟比 160.5±87.5 分钟，P=0.113）和手术出血量（743.1±630.5 毫升比 539.5±384.4 毫升，P=0.354）无差异。然而，两组间医疗并发症发生率（25.7%比 52.6%，P=0.048）和 3 个月再入院率（8.6%比 35.3%，P=0.045）有显著差异。然而，ESRD 组 3 个月死亡率（10.5%比 2.9%，P=0.28）和假关节发生率（35.3%比 9.1%，P=0.047）较高，但前者差异无统计学意义。
结论
当为 ESRD 患者进行脊柱手术时，外科医生应考虑到与手术相关的高发病率和假关节的可能性。
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