Factors affecting postoperative activities of daily living in patients with osteoporotic vertebral collapse with neurological deficits

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• 作者：Masafumi Kashii ; Ryoji Yamazaki ; Tomoya Yamashita…
• 关键词：Osteoporotic vertebral collapse ; Neurological impairment ; Activities of daily living ; Alkaline phosphatase ; Chronic kidney disease
• 刊名：Journal of Bone and Mineral Metabolism
• 出版年：2015
• 出版时间：July 2015
• 年：2015
• 卷：33
• 期：4
• 页码：422-431
• 全文大小：648 KB
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• 作者单位：Masafumi Kashii (1)
  Ryoji Yamazaki (2)
  Tomoya Yamashita (3)
  Shinya Okuda (2)
  Takahito Fujimori (1)
  Yukitaka Nagamoto (1)
  Yuichi Tamura (4)
  Takenori Oda (2)
  Tetsuo Ohwada (3)
  Motoki Iwasaki (1)
  Hideki Yoshikawa (1)
  
  1. Department of Orthopedic Surgery, Faculty of Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
  2. Department of Orthopedic Surgery, Osaka Rousai Hospital, 1179-3 Nagasonecho, Sakai, Osaka, 591-8025, Japan
  3. Department of Orthopedic Surgery, Kansai Rousai Hospital, 3-1-69 Inabasou, Amagasaki, Hyogo, 660-8511, Japan
  4. Department of Orthopedic Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Metabolic Diseases
  Orthopedics
  Internal Medicine
  
• 出版者：Springer Japan
• ISSN：1435-5604

文摘

Surgical treatment of osteoporotic vertebral collapse (OVC) with neurological deficits presents significant clinical challenges because some patients have fragile bones and often have medical comorbidities, which affect the severity of osteoporosis. We hypothesized that clinical results of surgery in these patients depend on the extent of medical comorbidities that induce secondary osteoporosis. The aim of this study is to examine the effects of medical history and comorbidities on surgical outcomes for these patients, along with the factors that predict postoperative function in activities of daily living (ADL). We retrospectively reviewed data for 88 patients with OVC and neurological deficits who underwent surgery. We assessed clinical results regarding neurological deficits and function in ADL. The presence or absence of comorbidities responsible for secondary osteoporosis and treatments or medical events that affect bone metabolism were examined. We performed statistical analysis to examine prognostic factors for postoperative function in ADL. Of 88 patients, the distributions of comorbidities, treatment, and events in medical history were as follows: hypertension, 57 patients (64.8?%); chronic kidney disease (CKD) stage 3 or 4, 32 (36.4?%); diabetes mellitus, 16 (18.2?%); liver dysfunction, 11 (12.5?%); cardiovascular disease, 10 (11.4?%); rheumatoid arthritis, 9 (10.2?%); and glucocorticoid intake, 8 (9.1?%). Twenty-five patients (28.4?%) represented poor postoperative ADL (chair-bound or bed-bound), and 11 of 25 patients with poor postoperative ADL represented full neurological recovery. Multivariate analysis revealed decreased estimated glomerular filtration rate (odds ratio 0.96; 95?% confidence interval 0.93-.99; p?=?0.005) and a high serum alkaline phosphatase (ALP) level (odds ratio 1.01; 95?% CI 1.00-.02; p?=?0.01) were strong predictive factors for poor postoperative function in ADL. The majority of patients with poor postoperative function in ADL had advanced CKD with a disorder of bone metabolism as well as bone fragility.