骨质疏松症的治疗对老年腰椎结核患者术后快速康复的影响

Effect of osteoporosis therapy on enhanced recovery after surgery among elderly patients with lumbar tuberculosis

目的探讨围手术期骨质疏松症的治疗对老年腰椎结核患者术后快速康复的影响。方法回顾性分析2017年2月至2020年1月首都医科大学附属北京胸科医院收治的接受手术治疗的92例老年(年龄≥60岁)腰椎结核患者。入组患者均存在腰椎骨质疏松,所有患者均接受加速康复外科(enhanced recovery after surgery,ERAS)模式管理。将其中接受抗骨质疏松症治疗的患者作为观察组,共计48例;未接受抗骨质疏松症治疗的患者作为对照组,共计44例。通过比较两组患者的手术治疗时间、术中出血量、术后疼痛视觉模拟评分(visual analogue scale,VAS)变化情况、术后卧床时间、术后植骨融合时间、术后椎弓根螺钉松动情况、术后并发症发生率之间的差异,明确围手术期骨质疏松的治疗对老年腰椎结核患者术后快速康复的影响。结果92例患者腰椎结核均获得治愈。经抗骨质疏松症治疗后,观察组患者术后卧床时间[(3.17±0.83)周]、术后植骨融合时间[(3.73±1.73)个月]、术后椎弓根螺钉松动发生率(6.2%,3/48)均低于对照组[分别为(3.91±0.86)周、(4.39±1.37)个月、15.9%(7/44)],差异均有统计学意义(t=-4.208,P<0.001;t=-2.333,P=0.022;χ^(2)=4.310,P=0.038)。观察组和对照组患者在手术治疗时间[(182.71±52.16)min和(173.75±37.83)min]、术中出血量[(365.83±109.21)ml和(409.32±127.34)ml]、术后VAS评分改善情况[(5.29±1.24)分和(5.07±1.06)分]、术后并发症发生率[27.1%(13/48)和25.0%(11/44)]之间差异均无统计学意义(t=0.936,P=0.352;t=-1.762,P=0.088;t=1.033,P=0.304;χ^(2)=0.231,P=0.631)。结论围手术期抗骨质疏松症治疗能够缩短患者术后卧床时间,维持椎弓根螺钉位置,加速植骨融合,可以作为老年腰椎结核并发骨质疏松患者ERAS措施中的组成部分。

Objective To investigate the effect of perioperative osteoporosis treatment on enhanced recovery after surgery(ERAS)among elderly patients with lumbar tuberculosis.Methods Retrospective analysis was performed on 92 elderly patients(age≥60 years)with lumbar tuberculosis who received surgical treatment in Beijing Chest Hospital of Capital Medical University from February 2017 to January 2020.All patients enrolled in the study had comorbidity of lumbar osteoporosis,and all patients received ERAS mode management.The patients were divided into the experimental group(48 cases)receiving anti-osteoporosis treatment and the control group(44 cases)not receiving anti-osteoporosis treatment.The effects of perioperative osteoporosis treatment on ERAS among elderly patients with lumbar tuberculosis were determined by comparing the differences of operative time,intraoperative blood loss,postoperative VAS score changes,postoperative bed time,postoperative bone graft fusion time,postoperative pedicle screw loosening,and postoperative complication rate.Results Lumbar tuberculosis was cured in all enrolled patients.After anti-osteoporosis treatment,postoperative bed rest time((3.17±0.83)weeks),postoperative bone graft fusion time((3.73±1.73)months)and postoperative incidence of pedicle screw loosening(6.2%,3/48)in the experiemental group were lower than those((3.91±0.86)weeks,(4.39±1.37)months,15.9%(7/44))in the control group,the differences were statistically significant(t=-4.208,P<0.001;t=-2.333,P=0.022;χ^(2)=4.310,P=0.038).There were no significant differences in operative time((182.71±52.16)min,(173.75±37.83)min),intraoperative blood loss((365.83±109.21)ml,(409.32±127.34)ml),postoperative VAS score improvement(5.29±1.24,5.07±1.06)and postoperative complication rate(27.1%(13/48),25.0%(11/44))between the two groups(t=0.936,P=0.352;t=-1.762,P=0.088;t=1.033,P=0.304;χ^(2)=0.231,P=0.631).Conclusion Perioperative anti-osteoporosis therapy is an important part of ERAS measures for elderly lumbar tuberculosis patients complicated with osteoporosis,which can shorten postoperative bed time,maintain pedicle screw position,and accelerate bone graft fusion.