Uehara Masashi, Ikegami Shota, Takizawa Takashi, Oba Hiroki, Yokogawa Noriaki, Sasagawa Takeshi, Nakashima Hiroaki, Segi Naoki, Ito Sadayuki, Funayama Toru, Eto Fumihiko, Yamaji Akihiro, Watanabe Kota, Nori Satoshi, Takeda Kazuki, Furuya Takeo, Yunde Atsushi, Nakajima Hideaki, Yamada Tomohiro, Hasegawa Tomohiko, Terashima Yoshinori, Hirota Ryosuke, Suzuki Hidenori, Imajo Yasuaki, Tonomura Hitoshi, Sakata Munehiro, Hashimoto Ko, Onoda Yoshito, Kawaguchi Kenichi, Haruta Yohei, Suzuki Nobuyuki, Kato Kenji, Uei Hiroshi, Sawada Hirokatsu, Nakanishi Kazuo, Misaki Kosuke, Terai Hidetomi, Tamai Koji, Kuroda Akiyoshi, Inoue Gen, Kakutani Kenichiro, Kakiuchi Yuji, Kiyasu Katsuhito, Tominaga Hiroyuki, Tokumoto Hiroto, Iizuka Yoichi, Takasawa Eiji, Akeda Koji, Takegami Norihiko, Funao Haruki, Oshima Yasushi, Kaito Takashi, Sakai Daisuke, Yoshii Toshitaka, Ohba Tetsuro, Otsuki Bungo, Seki Shoji, Miyazaki Masashi, Ishihara Masayuki, Okada Seiji, Imagama Shiro, Kato Satoshi
Department of Orthopaedic Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan.
Spine Surg Relat Res. 2024 May 10;8(6):575-582. doi: 10.22603/ssrr.2023-0118. eCollection 2024 Nov 27.
Preoperative estimations of blood loss are important when planning surgery for cervical spine injuries in older adults. The association between ankylosis and blood loss in perioperative management is of particular interest. This multicenter database review aimed to evaluate the impact of ankylosis on surgical blood loss volume in elderly patients with cervical spine injury.
The case histories of 1512 patients with cervical spine injury at among 33 institutions were reviewed. After the exclusion of patients without surgery or whose blood loss or ankylosis status was unclear, 793 participants were available for analysis. Differences in blood loss volume were compared between the Ankylosis (+) group with ankylosis at the cervical level and the Ankylosis (-) group without by the inverse probability of treatment weighting (IPTW) method using a propensity score.
Of the 779 patients (mean age: 75.0±6.3 years) eligible for IPTW calculation, 257 (32.4%) had ankylosis at the cervical level. The mean blood loss volume was higher in Ankylosis (+) patients than in Ankylosis (-) patients (P<0.001). This difference did not reach statistical significance when weighted by background factors, with mean blood loss of 244 mL and 188 mL, respectively, after adjustment.
This study revealed that ankylosis was significantly associated with increased blood loss volume when unadjusted by surgical time. Elderly patients with cervical spine injury accompanied by ankylosis appear predisposed to higher bleeding and severe hemorrhage, both as a result of the condition and their particular demographic characteristics.
在为老年患者计划颈椎损伤手术时，术前预估失血量很重要。强直性脊柱炎与围手术期管理中失血量之间的关联尤其令人关注。这项多中心数据库回顾旨在评估强直性脊柱炎对老年颈椎损伤患者手术失血量的影响。
回顾了33家机构中1512例颈椎损伤患者的病历。排除未接受手术或失血量或强直性脊柱炎状态不明的患者后，793名参与者可供分析。使用倾向评分通过治疗权重逆概率（IPTW）方法比较颈椎水平有强直性脊柱炎的强直性脊柱炎（+）组和无强直性脊柱炎的强直性脊柱炎（-）组之间的失血量差异。
在779例符合IPTW计算条件的患者（平均年龄：75.0±6.3岁）中，257例（32.4%）颈椎水平有强直性脊柱炎。强直性脊柱炎（+）患者的平均失血量高于强直性脊柱炎（-）患者（P<0.001）。按背景因素加权后，这种差异未达到统计学意义，调整后平均失血量分别为244 mL和188 mL。
本研究表明，在未按手术时间调整时，强直性脊柱炎与失血量增加显著相关。伴有强直性脊柱炎的老年颈椎损伤患者似乎因病情及其特定的人口统计学特征而更容易出血和发生严重出血。
