高龄短节段腰椎融合患者术后早期功能康复的安全性及有效性

Safety and efficacy of early functional rehabilitation in elderly patients after short-segment lumbar spinal fusion surgery

中文关键词:  短节段腰椎融合术  高龄  早期功能康复  并发症

英文关键词:Short-segment lumbar spinal fusion surgery  Elderly  Early functional rehabilitation  Complications

中文摘要:

  【摘要】 目的：评估高龄患者（年龄≥75岁）短节段腰椎融合手术后早期功能康复的安全性和有效性。方法：回顾性分析2018年1月~2021年4月在我院接受单/双节段腰椎融合手术的高龄患者，患者均在完成充分的术前评估后接受手术治疗。2019年7月开始对腰椎融合术后的高龄患者进行早期功能康复，即术后当日在康复医师指导下开始行规范床上康复锻炼，2d内下床活动，纳入早期康复组。2019年7月之前接受手术治疗的高龄患者术后采用传统康复措施，拔除引流管后开始下床活动，术后进行自主康复锻炼，纳入对照组。收集两组患者的临床资料，包括患者的基本信息[年龄、性别比、疾病种类、术前腰腿痛视觉模拟（VAS）评分、Oswestry功能障碍指数（ODI）、合并症、手术史和烟酒史]、手术相关资料（手术时间、术中出血量、手术节段）和结局指标（下床时间、拔除引流管时间、术后90d内的并发症情况、再入院率、术后住院时间以及术后额外的阿片类药物的使用情况）。结果：共纳入188例患者，早期康复组94例，对照组94例。早期康复组患者合并下肢静脉瓣膜功能不全及既往手术史比率较对照组高（46% vs 22%，P＜0.01；72% vs 55%，P=0.02），其余基线资料及手术相关资料与对照组比较无显著性差异（P＞0.05）。早期康复组患者首次下地时间和拔除引流管时间较对照组明显提前（1.8±0.9d vs 4.5±1.6d和2.2±0.26d vs 3.6±0.25d，P＜0.01），术后低蛋白血症的发生率低于对照组（28% vs 43%，P=0.03），其余并发症发生率、术后住院时间（7.0±3.3d vs 8.7±4.3d，P=0.06）及90d内的再入院率（3% vs 7%，P=0.12）均无显著性差异；早期康复组患者术后额外应用阿片类药物比率显著性低于对照组(12% vs 34%，P=0.00)。结论：高龄单节段或双节段腰椎融合手术患者术后早期接受功能康复锻炼不会增加术后并发症的发生率、短期再入院率及住院时间，同时减少了引流管留置时间、术后低蛋白血症发生率和额外阿片类药物的应用。

英文摘要:

  【Abstract】 Objectives: To explore the safety and efficacy of early functional rehabilitation in elderly patients(aged 75 years and older) after short-segment lumbar spinal fusion surgery. Methods: A retrospective review was performed on the elderly patients underging one- or two-segment lumbar fusion surgery after sufficient preoperative assessment in our hospital between January 2018 and April 2021. Patients who underwent lumbar fusion surgery after July 2019 received early functional rehabilitation of bed rehabilitation exercises under the guidance of rehabilitation physicians right postoperative on the day of surgery and ambulation within 2 days after surgery, and they were included in the early functional rehabilitation group. Patients surgically operated before July 2019 received conventional rehabiliation measures of ambulation after removal of the drainage tube and autonomous function exercise, and they were included in the control group. Clinical data of patients were collected, including baseline data(age, gender, primary diagnosis, preoperative VAS score of leg and low back pain, ODI, comorbidities, surgical history, and history of tobacco and alcohol), surgery-related data(operative time, intraoperative blood loss, fused segment), and surgical outcomes(time of first ambulation, time of drainage tube removal, complications within 90 days after surgery, readmission rate, length of postoperative hospital stay, and use of additional opioids after surgery). Results: A total of 188 patients were enrolled, including 94 patients in the early functional rehabilitation group and 94 patients in the control group. The rates of lower limb venous valvular insufficiency and surgical history were higher in early functional rehabilitation group than in control group(46% vs 22%, P＜0.01; 72% vs 55%, P=0.02), and no significance differences were observed in other baseline data and surgery-related data between groups(P＞0.05). The time of the first ambulation and removal of drainage tube was earlier in early functional rehabilitation group than control group(1.8±0.9d vs 4.5±1.6d and 2.2±0.3d vs 3.6±0.3d, P＜0.01). The incidence of postoperative hypoproteinemia in the early functional rehabilitation group was lower than that in the control group(28% vs 43%, P=0.03). There was no significant difference in the incidence of other complications, the length of postoperative hospital stay(7.0±3.3d vs 8.7±4.3d, P=0.06), and the rate of readmission within 90 days(3% vs 7%, P=0.12). The rate of additional postoperative opioids use was lower in the early functional rehabilitation group than in the control group(12% vs 34%, P=0.00). Conclusions: Early functional rehabilitation in patients aged 75 and older undergoing one- or two-level lumbar fusion surgery did not increase the incidence of postoperative complications, short-term readmission rate, or length of stay, which also decreased the retention time of drainage tube, incidence of postoperative hypoproteinemia, and the use of additional opioids.