BACKGROUND CONTEXT

The management of trauma patients with ankylosing spinal disorders has become an issue of increasing interest. Geriatric patients frequently sustain unstable extension type vertebral fractures with ankylosed spines. In this population, studies have shown that early surgery for other injuries such as hip fractures may reduce patient complications and mortality. These studies have changed patient care protocols in many medical centers worldwide.

PURPOSE

We aim to assess the relationship between the timing of surgery for unstable vertebral fractures in ankylosed spines in the geriatric population and patient outcomes.

STUDY DESIGN/SETTING

Retrospective clinical study conducted in a tertiary hospital.

PATIENT SAMPLE

Patients included were those diagnosed with isolated thoracolumbar extension type fractures and a spinal ankylosing disorder over 65 years old following minor trauma and with no additional injuries or neurological deficit.

OUTCOME MEASURES

Primary outcome measures included postoperative medical complications and mortality at 1 and 6 months. Secondary outcome measures included rehospitalization rates, length of stay, and surgical site infections.

METHODS

We searched our department's database for all that met our inclusion criteria who underwent surgery. The difference in patient outcomes that underwent early surgery defined as less than 72 hours from diagnosis as opposed to those that underwent later surgery was assessed.

RESULTS

A total of 82 patients underwent surgery following a diagnosis of an extension type thoracolumbar fracture at our institution between 2015 and 2021. Of these, 50 met inclusion criteria. Nineteen patients underwent surgery less than 72 hours from diagnosis and 31 more than 72 hours from diagnosis. No difference was found in age, functional status, and Elixhauser comorbidity scores between the groups. A statistically significant difference in perioperative patient complications between the early and the late groups (p=.005) was found. Mortality at six-months was significantly different between the groups as well (p=.035). There was no statistically significant difference between the groups when comparing surgical site infections, length of hospital stay, rehospitalization within a month, and perioperative mortality.

CONCLUSIONS

Time to surgery affects complication rates and six-month mortality in geriatric patients with spinal ankylosing disorders presenting with an isolated unstable hyperextension type thoracolumbar fracture. Early surgery of less than 72 hours from presentation in this patient population is recommended.

中文翻译：

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患有强直性疾病的老年患者胸腰椎伸展型骨折的早期手术可降低患者并发症和死亡率

背景语境

患有强直性脊柱疾病的外伤患者的管理已成为人们日益关注的问题。老年患者经常遭受不稳定的伸展型椎体骨折并伴有强直性脊柱。在这一人群中，研究表明，髋部骨折等其他损伤的早期手术可能会减少患者并发症和死亡率。这些研究改变了全球许多医疗中心的患者护理规程。

目的

我们旨在评估老年人群强直性脊柱不稳定椎体骨折的手术时机与患者预后之间的关系。

研究设计/设置

在三级医院进行的回顾性临床研究。

患者样本

患者包括被诊断为孤立性胸腰椎伸展型骨折和脊柱强直性障碍的患者，年龄在 65 岁以上，在轻微外伤后没有其他损伤或神经功能缺损。

结果测量

主要结果指标包括术后并发症以及 1 个月和 6 个月时的死亡率。次要结果指标包括再住院率、住院时间和手术部位感染。

方法

我们在我们部门的数据库中搜索了所有符合我们纳入标准的接受手术的人。评估了接受早期手术（定义为诊断后 72 小时以内）的患者结果与接受较晚手术的患者结果的差异。

结果

2015 年至 2021 年间，共有 82 名患者在诊断为延伸型胸腰椎骨折后接受了手术。其中，50 名患者符合纳入标准。19 名患者在诊断后 72 小时内接受了手术，31 名患者在诊断后 72 小时以上接受了手术。两组之间的年龄、功能状态和 Elixhauser 合并症评分没有差异。发现早期组和晚期组的围手术期患者并发症存在统计学显着差异 (p=.005)。两组间六个月的死亡率也有显着差异 (p=.035)。在比较手术部位感染、住院时间、一个月内再次住院和围手术期死亡率时，两组之间没有统计学上的显着差异。

结论

手术时间会影响伴有孤立性不稳定过度伸展型胸腰椎骨折的脊柱强直性疾病老年患者的并发症发生率和 6 个月死亡率。建议在该患者群体中就诊后 72 小时内进行早期手术。