■接受脊柱手术的成年人通常患有潜在的骨质疏松症,这可能是术后并发症的危险因素。尽管已经描述了这些关联,在脊柱手术人群中,骨质疏松症仍然严重未被诊断和治疗不足。一个彻底的,全面的系统评价总结骨矿物质密度(BMD)与腰椎融合手术的特定并发症之间的关系,可能是提高认识和支持临床实践变化的宝贵资源。
■PubMed,Embase,和WebofScience数据库被搜索到关于BMD的原始临床研究文章,或代理度量,作为成人退行性疾病或畸形择期腰椎融合术并发症的预测指标。终点包括网箱沉降,螺钉松动,假关节,椎骨骨折,交界处并发症,再操作。
■共纳入71项研究,包括12,278名患者。总的来说,研究人群中相当大的异质性,骨健康评估方法,临床终点的定义和评估排除了荟萃分析。然而,低BMD与较高的植入物故障率相关,如保持架下沉和螺钉松动,常被诊断为并发假关节。骨质疏松也是近端交界性脊柱后凸的重要危险因素,特别是由于骨折。许多研究发现手术部位特定的BMD可以最好地预测局灶性并发症。功能结果处理不一致。
■我们的研究结果表明,骨质疏松是腰椎融合术机械性并发症的重要危险因素。这些结果强调了术前骨质疏松筛查的重要性,这允许高风险患者的医疗和手术优化。这篇综述还强调了择期手术患者骨健康评估面临的当前实际挑战。未来使用标准化方法的前瞻性研究对于加强现有证据是必要的,确定最佳预测阈值,并建立特定专业的实践指南。同时,了解骨质疏松症的手术含义和术前筛查的实用性可以提供更多的信息,有效的病人护理。
UNASSIGNED: Adults undergoing spine surgery often have underlying osteoporosis, which may be a risk factor for postoperative complications. Although these associations have been described, osteoporosis remains profoundly underdiagnosed and undertreated in the spine surgery population. A thorough, comprehensive systematic review summarizing the relationships between bone mineral density (BMD) and specific complications of lumbar fusion surgery could be a valuable resource for raising awareness and supporting clinical practice changes.
UNASSIGNED: PubMed, Embase, and Web of Science databases were searched for original clinical research articles reporting on BMD, or surrogate measure, as a predictor of complications in adults undergoing elective lumbar fusion for degenerative disease or deformity. Endpoints included cage subsidence, screw loosening, pseudarthrosis, vertebral fracture, junctional complications, and reoperation.
UNASSIGNED: A total of 71 studies comprising 12,278 patients were included. Overall, considerable heterogeneity in study populations, methods of bone health assessment, and definition and evaluation of clinical endpoints precluded meta-analysis. Nevertheless, low BMD was associated with higher rates of implant failures like cage subsidence and screw loosening, which were often diagnosed with concomitant pseudarthrosis. Osteoporosis was also a significant risk factor for proximal junctional kyphosis, particularly due to fracture. Many studies found surgical site-specific BMD to best predict focal complications. Functional outcomes were inconsistently addressed.
UNASSIGNED: Our findings suggest osteoporosis is a significant risk factor for mechanical complications of lumbar fusion. These results emphasize the importance of preoperative osteoporosis screening, which allows for medical and surgical optimization of high-risk patients. This review also highlights current practical challenges facing bone health evaluation in patients undergoing elective surgery. Future prospective studies using standardized methods are necessary to strengthen existing evidence, identify optimal predictive thresholds, and establish specialty-specific practice guidelines. In the meantime, an awareness of the surgical implications of osteoporosis and utility of preoperative screening can provide for more informed, effective patient care.