Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in posterolateral lumbar spine fusion: complications in the elderly.
Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in posterolateral lumbar spine fusion: complications in the elderly.
复制标题
重组人骨形态发生蛋白2（RHBMP-2）在后外侧腰椎融合中：老年人的并发症。
DOI：
10.1186/1749-799x-8-1
复制
发表时间：
2013-01-14
影响因子：
2.6
通讯作者：
Sietsema DL
中科院分区：
文献类型：
--
作者：
Hoffmann MF;Jones CB;Sietsema DL
2002 - 2009年对1430例接受腰椎融合术患者的回顾性队列研究。目的：本研究旨在比较和评估老年患者与年轻患者中需要再次手术的并发症数量。
重组人骨形态发生蛋白 - 2（rhBMP - 2）多年来一直被超适应证用于腰椎后外侧融合内固定术。许多系列研究已证明了可预测的愈合率和再次手术情况。据报道老年患者的并发症发生率各不相同。
对所有同意使用rhBMP - 2进行≤3个节段腰椎后外侧融合内固定术的患者进行回顾性评估。分析了患者的人口统计学资料、体重指数、合并症、节段数量、相关的椎间融合以及骨空隙填充剂的类型。将患者年龄分为小于65岁和大于等于65岁两组。记录与手术操作相关的并发症。
排除后，对482例连续患者进行了评估，其中男性占42.1%，女性占57.9%。平均年龄为62岁，其中250例（51.9%）<65岁，232例（48.1%）≥65岁。≥65岁的患者在医院停留的时间（5.0天）比年轻患者（4.5天）长（p = 0.005）。
需要再次手术的并发症包括：需要减压的急性血清肿形成15/482例，占3.1%；骨过度生长4/482例，占0.8%；需要清创的感染11/482例，占2.3%；因有症状的骨不连而进行翻修融合18/482例，占3.7%。两个年龄组之间并发症无显著差异。在年龄组之间，医学合并症和手术操作存在统计学差异。65岁以上患者进行的融合节段更长（2.1个节段对比1.7个节段，p = 0.001）。
尽管年龄较大且合并症较多，但与接受rhBMP - 2腰椎减压融合术的较年轻且健康的患者相比，老年患者的并发症和再次手术率相似。
Retrospective cohort study of 1430 patients undergoing lumbar spinal fusion from 2002 - 2009. Objective: The goal of this study was to compare and evaluate the number of complications requiring reoperation in elderly versus younger patients. rhBMP-2 has been utilized off label for instrumented lumbar posterolateral fusions for many years. Many series have demonstrated predictable healing rates and reoperations. Varying complication rates in elderly patients have been reported. All patients undergoing instrumented lumbar posterolateral fusion of ≤ 3 levels consenting to utilization of rhBMP-2 were retrospectively evaluated. Patient demographics, body mass index, comorbidities, number of levels, associated interbody fusion, and types of bone void filler were analyzed. The age of patients were divided into less than 65 and greater than or equal to 65 years. Complications related to the performed procedure were recorded. After exclusions, 482 consecutive patients were evaluated with 42.1% males and 57.9% females. Average age was 62 years with 250 (51.9%) < 65 and 232 (48.1%) ≥ 65 years. Patients ≥ 65 years of age stayed longer (5.0 days) in the hospital than younger patients (4.5 days) (p=0.005). Complications requiring reoperation were: acute seroma formation requiring decompression 15/482, 3.1%, bone overgrowth 4/482, 0.8%, infection requiring debridement 11/482, 2.3%, and revision fusion for symptomatic nonunion 18/482, 3.7%. No significant differences in complications were diagnosed between the two age groups. Statistical differences were noted between the age groups for medical comorbidities and surgical procedures. Patients older than 65 years underwent longer fusions (2.1 versus 1.7 levels, p=0.001). Despite being older and having more comorbidities, elderly patients have similar complication and reoperation rates compared to younger healthier patients undergoing instrumented lumbar decompression fusions with rhBMP-2.