高龄退变性脊柱侧凸患者合并症对术后并发症发生率的影响研究  

The influence of comorbidity on the incidence of postoperative complications in elderly patients with adult degenerative scoliosis

作　　者：路博 张彤童 刘宇琦 孙祥耀 张庆明[4] 曹立[4] 孙文志 胡海量[4] 鲁世保[4] LU Bo;ZHANG Tong-tong;LIU Yu-qi;SUN Xiang-yao;ZHANG Qing-ming;CAO Li;SUN Wen-zhi;HU Hai-liang;LU Shi-bao(Department of Orthopedics,Hebei Petro China Center Hospital,Langfang,Hebei,065000,China)

机构地区：[1]河北中石油中心医院骨科,廊坊065000 [2]清华大学附属垂杨柳医院骨四科,北京100022 [3]首都医科大学宣武医院急诊科,北京100053 [4]首都医科大学宣武医院骨科,北京100053

出　　处：《中国骨与关节杂志》2023年第1期68-75,共8页Chinese Journal of Bone and Joint

基　　金：临床生物力学应用基础研究北京市重点实验室(1300-12200702);首都医科大学科研培育基金(1220010144);首都医科大学宣武医院2021年度国自然青年培育项目(QNPY2021018);北京市医院管理中心“青苗”计划(QML20210805);中国国家留学基金国家建设高水平大学公派研究生项目(20190811033);国家自然科学基金面上项目(81871794,81672201)。

摘　　要：目的评估高龄成人退变性脊柱侧凸(adult degenerative scoliosis,ADS)患者的合并症,并探讨这些合并症与ADS矫形术后临床疗效或手术后并发症的关系,进一步分析年龄对治疗效果的影响。方法本研究对318例60岁以上接受后路腰椎融合术(posterior lumbar interbody fusion,PLIF)治疗的ADS患者进行回顾性分析,根据患者年龄将其分为A组(年龄<80岁,n=252)以及B组(年龄≥80岁,n=66)进行比较。通过电子病历系统收集患者的年龄、性别、吸烟情况、体质量指数(body mass index,BMI)、病史及伴发疾病情况。并发症分为内科并发症(感染、心肺疾病、胃肠功能障碍、肾衰竭)和外科并发症[近端交界后凸(proximal junctional kyphosis,PJK)、内固定松动、脑脊液漏、假关节形成]。纳入研究的影像学参数主要包括,冠状位Cobb’s角(coronal Cobb’s angle,CA)、矢状位垂直轴(sagittal vertical axis,SVA)、骨盆投射角(pelvic incidence,PI)、腰椎前凸角(lumbar lordosis,LL)、骨盆投射角与腰椎前凸角之差(pelvic incidence minus lumbar lordosis mismatch,PI-LL)。采用Oswestry功能障碍指数(oswestry disability index,ODI)、日本骨科协会(Japanese Orthopaedic Association,JOA)评分、腰椎僵硬功能障碍指数(lumbar stiffness disability index,LSDI)和视觉模拟评分(visual analog scale,VAS)评价临床结果。利用单因素Logistic回归分析的结果建立受试者工作特征曲线(receiver operating characteristic curve,ROC),以确定年龄预测临床疗效的准确性。结果单变量线性回归分析发现末次随访时SVA(B=0.129,P=0.021)、术后ODI(B=0.219,P<0.001)、术后JOA(B=0.197,P<0.001)与年龄呈正相关。单变量Logistic回归分析结果显示,PJK(B=0.043,P=0.012)、内固定松动(B=0.054,P=0.009)与年龄呈正相关。ROC曲线分析计算预测PJK和内固定松动发生风险的年龄阈值。结果显示,年龄对PJK和内固定松动的预测阈值分别为71.5(AUC=0.591)和80.5(AUC=0.606)。结论高Objective To evaluate the comorbidities of elderly ADS patients,and to explore the relationship between these comorbidities and the clinical efficacy or postoperative complications of ADS orthopaedic surgery,and to further analyze the effect of age on the therapeutic effect.Methods A retrospective analysis was conducted on ADS patients over 60 years of age who received posterior lumbar interbody fusion(PLIF),and they were divided into the group A(age<80 years)and group B(age≥80 years)according to their age.Age,sex,smoking status,body mass index(BMI),medical history and co-morbidity were collected through an electronic medical record system.The complications were divided into medical complications(infection,cardiopulmonary disease,gastrointestinal dysfunction,renal failure)and surgical complications(proximal junctional kyphosis,internal fixation loosens,cerebrospinal fluid leakage,pseudojoint formation).Imaging parameters mainly included coronal Cobb’s angle(CA),sagittal vertical axis(SVA),pelvic projection angle(SVA),lumbar lordosis(PI),lumbar lordosis(LL),pelvic projection angle and lumbar lordosis(PI-LL).The Oswestry Disability Index(ODI),Japanese Orthopaedic Association(JOA),Lumbar Stiffness Disability Index(LSDI),and Visual analog Scale(VAS)were used to evaluate clinical outcomes.The results of univariate logistic regression analysis were used to establish receiver operating characteristic curve(ROC curve)to determine the accuracy of age in predicting clinical efficacy.P<0.05 was statistically significant.Results A total of 318 ADS patients were included in this study.There were 252 cases in the young group and 66 cases in the old group.Univariate linear regression analysis showed that SVA at the last follow-up(B=0.129,P=0.021),postoperative ODI(B=0.219,P<0.001),postoperative JOA(B=0.197,P<0.001)were positively correlated with age.Univariate logistic regression analysis showed that PJK(B=0.043,P=0.012)and loosening of internal fixation(B=0.054,P=0.009)were positively correlated with age.ROC curve analysis

关 键 词：脊柱侧凸 老年人 手术后并发症 治疗结果 

分 类 号：R682.3[医药卫生—骨科学]