The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial.
The impact of diabetes on the outcomes of surgical and nonsurgical treatment of patients in the spine patient outcomes research trial.
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DOI：
10.1097/brs.0b013e3181ef9d8c
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发表时间：
2011-02-15
期刊：
影响因子：
3
通讯作者：
Weinstein JN
中科院分区：
文献类型：
--
作者：
Freedman MK;Hilibrand AS;Blood EA;Zhao W;Albert TJ;Vaccaro AR;Oleson CV;Morgan TS;Weinstein JN
对脊柱患者结局研究试验（SPORT）中入选的糖尿病患者和非糖尿病患者进行的次要分析。比较糖尿病和非糖尿病脊柱患者的手术结果和并发症。糖尿病患者易患合并症，可能混淆脊柱疾病患者的诊断和治疗。将199例糖尿病患者的基线特征和结局与纳入脊柱患者结局研究试验的2405例非糖尿病患者的基线特征和结局进行比较，以诊断椎间盘突出（IDH）、椎管狭窄（SpS）和退行性脊椎前移（DS）。主要结局指标包括36项简明健康调查表（SF-36）健康状况问卷和奥斯韦斯特里残疾指数。与非糖尿病患者相比，糖尿病患者年龄明显更大，体重指数更高。合并症，包括高血压、中风、心血管疾病和关节疾病，在糖尿病患者中比非糖尿病患者更常见。与接受非手术治疗的糖尿病患者相比，糖尿病和IDH患者在手术干预后的疼痛和功能方面没有显著改善。与非手术治疗相比，SpS和DS的糖尿病患者在手术干预后疼痛和功能的改善明显更大。在接受手术的患者中，非糖尿病SpS患者的功能改善略高于糖尿病患者（SF-36身体功能，P = 0.062）。在接受DS手术的患者中，糖尿病患者的疼痛或功能改善程度不如非糖尿病人群（SF-36身体疼痛，P = 0.003;身体功能，P = 0.002）。糖尿病患者的术后并发症发生率高于非糖尿病SpS患者（P = 0.002）。DS合并糖尿病患者的术后（P = 0.028）和术中（P = 0.029）血液置换量增加。合并SpS和DS的糖尿病患者受益于手术，尽管合并糖尿病的老年SpS患者有更多的术后并发症。IDH合并糖尿病患者没有从手术干预中获益。
A secondary analysis comparing diabetic patients with nondiabetic patients enrolled in the Spine Patient Outcomes Research Trial (SPORT). To compare surgical outcomes and complications between diabetic and nondiabetic spine patients. Patients with diabetes are predisposed to comorbidities that may confound the diagnosis and treatment of patients with spinal disorders. Baseline characteristics and outcomes of 199 patients with diabetes were compared with those of the nondiabetic population in a total of 2405 patients enrolled in the Spine Patient Outcomes Research Trial for the diagnoses of intervertebral disc herniation (IDH), spinal stenosis (SpS), and degenerative spondylolisthesis (DS). Primary outcome measures include the 36-Item Short Form Health Survey (SF-36) Health Status questionnaire and the Oswestry Disability Index. Patients with diabetes were significantly older and had a higher body mass index than nondiabetic patients. Comorbidities, including hypertension, stroke, cardiovascular disease, and joint disease, were significantly more frequent in diabetic patients than in nondiabetic patients. Patients with diabetes and IDH did not make significant gains in pain and function with surgical intervention relative to diabetic patients who underwent nonoperative treatment. Diabetic patients with SpS and DS experienced significantly greater improvements in pain and function with surgical intervention when compared with nonoperative treatment. Among those who had surgery, nondiabetic patients with SpS achieved marginally significantly greater gains in function than their diabetic counterparts (SF-36 physical function, P = 0.062). Among patients who had surgery for DS, diabetic patients did not have as much improvement in pain or function as did the nondiabetic population (SF-36 bodily pain, P = 0.003; physical function, P = 0.002). Postoperative complications were more prevalent in patients with diabetes than in nondiabetic patients with SpS (P = 0.002). There was an increase in postoperative (P = 0.028) and intraoperative (P = 0.029) blood replacement in DS patients with diabetes. Diabetic patients with SpS and DS benefited from surgery, though older SpS patients with diabetes have more postoperative complications. IDH patients with diabetes did not benefit from surgical intervention.