背景:全球人口老龄化对脊柱外科医生提出了越来越大的挑战。脊柱外科的进步,包括微创技术,有更广泛的治疗选择,可能使老年患者受益。本研究旨在探讨七十岁和八十岁老人脊柱手术的临床效果。
方法:本回顾性分析,在美国高等教育中心进行,包括70岁及以上因退行性疾病而接受选择性脊柱手术的患者。数据包括Charlson合并症指数,ASA分类,外科手术,术中和术后并发症,和再操作率。这项研究的目的是描述我们的老年患者队列的结果,并辨别七十岁和八十岁之间是否存在差异。
结果:在符合纳入标准的120例患者中,各年龄组术前因素差异无统计学意义(p>0.05)。值得注意的是,七十年代组的平均融合水平较高(2.36vs.0.38,p=0.001),虽然八十岁组接受微创手术的比例更高(p=0.012),导致年龄最大组的总体出血减少(p<0.001)。流动性结果在七十多岁的人中更有利,而八十岁的老人倾向于保持或经历流动性下降(p=0.012)。共记录了6例(5%)术中并发症和12例(10%)术后并发症,两组之间无统计学差异。
结论:本病例系列显示七十岁老人和八十岁老人可以通过择期脊柱手术获得良好的临床结果。脊柱外科医生应该精通老年人的临床和外科护理,提供考虑增加的合并症负担和增加的脆弱性的最佳管理。
The aging global population presents an increasing challenge for spine surgeons. Advancements in spine surgery, including minimally invasive techniques, have broadened treatment options, potentially benefiting older patients. This study aims to explore the clinical outcomes of spine surgery in septuagenarians and octogenarians.
This retrospective analysis, conducted at a US tertiary center, included patients aged 70 and older who underwent elective spine surgery for degenerative conditions. Data included the Charlson Comorbidity Index (CCI), ASA classification, surgical procedures, intraoperative and postoperative complications, and reoperation rates. The objective of this study was to describe the outcomes of our cohort of older patients and discern whether differences existed between septuagenarians and octogenarians.
Among the 120 patients meeting the inclusion criteria, there were no significant differences in preoperative factors between the age groups (P > 0.05). Notably, the septuagenarian group had a higher average number of fused levels (2.36 vs. 0.38, P = 0.001), while the octogenarian group underwent a higher proportion of minimally invasive procedures (P = 0.012), resulting in lower overall bleeding in the oldest group(P < 0.001). Mobility outcomes were more favorable in septuagenarians, whereas octogenarians tended to maintain or experience a decline in mobility(P = 0.012). A total of 6 (5%) intraoperative complications and 12 (10%) postoperative complications were documented, with no statistically significant differences observed between the groups.
This
case series demonstrates that septuagenarians and octogenarians can achieve favorable clinical outcomes with elective spine surgery. Spine surgeons should be well-versed in the clinical and surgical care of older adults, providing optimal management that considers their increased comorbidity burden and heightened fragility.