75세 이상 초고령 환자 퇴행성 척추 질환에 시행한 요추 유합술의 임상 결과: 65세 이상 75세 미만 고령 환자군과의 비교 연구 (Clinical Results of Lumbar Spinal Fusion in Degenerative Spine Disease in Patients over 75 Years Old: Comparative Study of Patients over 65 Years Old and Patients less than 75 Years Old)

서지정보

· 발행기관 : 대한정형외과학회
· 수록지 정보 : 대한정형외과학회지 / 47권 / 5호 / 330 ~ 336페이지
· 저자명 : 조규정, 박승림, 박명주

초록

목적: 75세 이상 초고령 환자에 시행한 요추 유합술 후 임상 결과가 65-75세 환자의 결과와 차이가 있는가를 알아보았다.
대상 및 방법: 퇴행성 척추 질환으로 요추 유합술을 시행하고 12개월 이상 추적 관찰된 75세 이상 27명과 65-74세 환자 98명을 대상으로 하였다. 퇴행성 척추측만증 및 재수술 환자는 제외하였다. 수술 범위는 3분절 이하 요추 유합술만 포함하였다. 환자의 술 전 American Society of Anesthesiologists (ASA) 점수, 수술 전과 최종 추시 시 시각통증등급(visual analog scale, VAS), Oswestry 장애지수(Oswestry disability index, ODI), 술 후 합병증을 비교 분석하였다.
결과: 75세 이상 환자군에서 수술 전 ASA 점수가 높고 골다공증이 심하였다. 수술 전후 통증(VAS) 및 ODI 변화는 두 군 간 통계적으로 유의한 차이가 없었다. 수술 후 발생한 조기 합병증과 후기 합병증에도 차이가 없었다.
결론: 퇴행성 요추 질환으로 요추 유합술을 시행한 75세 이상의 초고령 환자군에서 65-75세 환자군과 비교하여 수술 전 전반적인 건강상태는 좋지 않았지만, 수술 후 통증 호전과 만족도에서는 차이가 없었다.

영어초록

Purpose: The elderly patients have been known for high incidence of postoperative complications following a lumbar fusion surgery.
This study was conducted to determine the results of clinical outcomes after a lumbar fusion surgery in patients older than 75 years and to compare with those in patients between 65 and 74 years old.
Materials and Methods: One hundred twenty-five patients who underwent lumbar fusion were enrolled. The mean follow-up was 22.5±15.7 months. Preoperative diagnosis was spinal stenosis in 113 patients and degenerative spondylolisthesis in 12 patients.
Revision surgery or multi-level spinal fusion (>4 segments) was excluded. There were 27 patients in group A (>75 years) and 98patients in group B (65-74 years). Preoperative American Society of Anesthesiologists (ASA) scores, visual analog scale (VAS),Oswestry disability index (ODI), postoperative complications, and bone union rate were compared.
Results: The mean age was 78.6 years and 68.8 years in Group A and Group B, respectively. The mean preoperative ASA score was statistically different between group A and group B (p=0.025). The mean bone mineral density T score in group A was higher than that in group B (p=0.002). The mean VAS did not show a difference between the groups (p=0.171). There was no difference in the mean ODI between the groups in the improvement of VAS and ODI. The major and minor complications of early complications and late complications were observed without any statistical difference.
Conclusion: Although preoperative ASA score was higher and osteoporosis was severe in the elderly patients (>75 years old), the improvement of clinical outcome was satisfactory as much as younger patients (65-74 years old) following a lumbar fusion surgery for degenerative spinal disease.

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