Tomomatsu Yusuke, Takasawa Eiji, Iizuka Yoichi, Mieda Tokue, Inoue Hirokazu, Kimura Atsushi, Takeshita Katsushi, Sonoda Hiroyuki, Takakura Kenta, Sorimachi Yasunori, Ara Tsuyoshi, Shida Kosuke, Nakajima Takashi, Tsutsumi Satoshi, Arai Hidekazu, Moridaira Hiroshi, Taneichi Hiroshi, Funayama Toru, Noguchi Hiroshi, Miura Kousei, Kobayashi Ryoichi, Iizuka Haku, Chazono Masaaki, Chikuda Hirotaka
Department of Orthopaedic Surgery, Gunma University, Maebashi, Gunma, Japan.
Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi-shi, Gunma, 371-8511, Japan.
Eur Spine J. 2025 Apr;34(4):1301-1308. doi: 10.1007/s00586-025-08673-8. Epub 2025 Feb 6.
This study aimed to elucidate the association between comorbid hypertension (HT) and diabetes mellitus (DM) (HT in DM) and clinical outcomes after cervical laminoplasty.
This retrospective multi-institutional study enrolled patients who underwent laminoplasty between 2008 and 2017. The primary outcome was the recovery rate of JOA score. The secondary outcome was in-hospital all-cause postoperative complications.
This study included 1002 patients (mean age, 66 years; 30% women) who were divided into 4 groups based on the presence of medically-treated HT and/or DM. The overall incidence of DM was 17%, and the prevalence of HT was 47% in diabetic patients. Patients with HT in DM showed similar preoperative JOA scores compared to those without both HT and DM. However, patients with HT in DM showed poorer postoperative JOA scores and worse JOA-RR (non-HT/DM, 48%; DM, 43%; HT, 37%; HT in DM, 28%; p < 0.05). Patients with HT in DM tended to have a higher risk of postoperative complications (2.5%, 5.4%, 3.0%, and 7.4%; p = 0.09), especially C5 palsy (0.8%, 3.0%, 1.7%, and 4.9%; p = 0.04). After adjusting confounders, the presence of HT in DM was an independent risk factor for failure to achieve the JOA-RR MCID (JOA-RR < 42%) (OR = 3.6).
Approximately half of patients with DM had HT. HT in DM was closely associated with unfavorable surgical outcomes, including an increased incidence of in-hospital postoperative complications and an elevated risk of C5 palsy. In contrast, patients with DM alone demonstrated relatively favorable outcomes.
本研究旨在阐明合并高血压（HT）和糖尿病（DM）（糖尿病合并高血压）与颈椎板成形术后临床结局之间的关联。
这项回顾性多机构研究纳入了2008年至2017年间接受板成形术的患者。主要结局是日本骨科学会（JOA）评分的恢复率。次要结局是住院期间的全因术后并发症。
本研究纳入了1002例患者（平均年龄66岁；30%为女性），根据药物治疗的高血压和/或糖尿病的存在情况分为4组。糖尿病的总体发病率为17%，糖尿病患者中高血压的患病率为47%。糖尿病合并高血压患者术前JOA评分与无高血压和糖尿病患者相似。然而，糖尿病合并高血压患者术后JOA评分较差，JOA恢复率（JOA-RR）也较差（非高血压/糖尿病组为48%；糖尿病组为43%；高血压组为37%；糖尿病合并高血压组为28%；p<0.05）。糖尿病合并高血压患者术后并发症风险往往较高（分别为2.5%、5.4%、3.0%和7.4%；p=0.09），尤其是C5麻痹（分别为0.8%、3.0%、1.7%和4.9%；p=0.04）。在调整混杂因素后，糖尿病合并高血压是未能达到JOA-RR最小临床重要差异（JOA-RR<42%）的独立危险因素（OR=3.6）。
约一半的糖尿病患者患有高血压。糖尿病合并高血压与不良手术结局密切相关，包括住院术后并发症发生率增加和C5麻痹风险升高。相比之下，单纯糖尿病患者的结局相对较好。
