在接受颈椎融合术的骨质减少患者中，使用特立帕肽与2年植入物失败和翻修几率增加有关。
Teriparatide use is associated with increased odds of 2-year implant failure and revision in osteopenic patients undergoing cervical fusion.
作者信息
Ng Mitchell K, Mastrokostas Paul G, Mastrokostas Leonidas E, Tabbaa Ameer, Johnson Matthew, Monsef Jad Bou, Razi Afshin E
机构信息
Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Department of Orthopaedic Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
出版信息
J Craniovertebr Junction Spine. 2025 Apr-Jun;16(2):157-161. doi: 10.4103/jcvjs.jcvjs_30_25. Epub 2025 Jul 3.
CONTEXT
Cervical fusion outcomes are influenced by bone quality, with osteopenia increasing the risk of implant failure and revision surgery. The impact of teriparatide in this population remains unclear.
AIMS
The aim of this study was to investigate the association between teriparatide use and 90-day medical complications, 2-year surgical complications, and hospital readmissions in this population.
SETTINGS AND DESIGN
A retrospective cohort analysis using the PearlDiver Mariner database from 2010 to 2022.
SUBJECTS AND METHODS
Patients undergoing cervical fusion were stratified by teriparatide use. Propensity score matching (1:5) was performed based on age, gender, Elixhauser Comorbidity Index, obesity, and bisphosphonate use. Primary outcomes included 90-day medical complications, 2-year surgical complications, surgical revisions, and hospital readmissions.
STATISTICAL ANALYSIS USED
Logistic regression models were used to calculate odds ratios (ORs) with a Bonferroni-corrected significance level of < 0.004.
RESULTS
Ninety-eight teriparatide-treated patients were matched to 487 controls. Teriparatide use was significantly associated with higher rates of 2-year implant failure (4.1% vs. 1.0%, = 0.003) and surgical revisions (54.1% vs. 4.7%, < 0.001). Logistic regression demonstrated increased odds of 2-year implant failure (OR 6.63, 95% confidence interval [CI]: 1.93-23.78, = 0.002) and surgical revisions (OR 27.83, 95% CI: 15.34-52.58, < 0.001) in the teriparatide group. No differences were observed in 90-day medical complications or readmission rates ( > 0.004).
CONCLUSIONS
Teriparatide use in osteopenic patients undergoing cervical fusion is associated with increased risks of 2-year implant failure and surgical revisions. These findings suggest that while teriparatide improves bone quality, its efficacy may be limited in this population. Future research should explore tailored interventions to optimize surgical outcomes in osteopenic patients.
背景
颈椎融合术的疗效受骨质质量影响，骨质减少会增加植入物失败和翻修手术的风险。特立帕肽在该人群中的影响尚不清楚。
目的
本研究旨在调查特立帕肽的使用与该人群90天内科并发症、2年外科并发症及再次入院之间的关联。
设置与设计
使用PearlDiver Mariner数据库对2010年至2022年的数据进行回顾性队列分析。
研究对象与方法
接受颈椎融合术的患者按是否使用特立帕肽进行分层。基于年龄、性别、埃利克斯豪泽合并症指数、肥胖症及双膦酸盐类药物使用情况进行倾向评分匹配（1:5）。主要结局包括90天内科并发症、2年外科并发症、手术翻修及再次入院。
所用统计分析方法
采用逻辑回归模型计算比值比（OR），经邦费罗尼校正后的显著性水平<0.004。
结果
98例接受特立帕肽治疗的患者与487例对照匹配。使用特立帕肽与2年植入物失败率（4.1%对1.0%，P = 0.003）及手术翻修率（54.1%对4.7%，P < 0.001）显著升高相关。逻辑回归显示，特立帕肽组2年植入物失败（OR 6.63，95%置信区间[CI]：1.93 - 23.78，P = 0.002）及手术翻修（OR 27.83，95% CI：15.34 - 52.58，P < 0.001）的几率增加。90天内科并发症或再次入院率未观察到差异（P > 0.004）。
结论
在接受颈椎融合术的骨质减少患者中使用特立帕肽与2年植入物失败及手术翻修风险增加相关。这些发现表明，虽然特立帕肽可改善骨质质量，但其在该人群中的疗效可能有限。未来研究应探索针对性干预措施，以优化骨质减少患者的手术结局。
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