Hedequist Daniel J, Emans John B, Hall John E
Orthopedic Surgery, Children's Hospital/Harvard Medical School, Boston, MA 02115, USA.
Spine (Phila Pa 1976). 2006 Jan 15;31(2):202-5. doi: 10.1097/01.brs.0000195162.14945.91.
A retrospective chart and radiographic review of patients with a Fontan physiology who underwent surgical correction of their scoliosis.
To evaluate the operative and perioperative treatment of patients with a Fontan physiology and scoliosis.
The survival rates in patients with complex congenital heart disease are improving, thus creating a subset of patients with complex physiology who will require surgical treatment of their scoliosis. The Fontan physiology is created surgically in patients born with a single functioning ventricle. These patients represent a significant anesthetic risk during spinal surgery, given their physiologic need for a sustained systemic preload. Currently, to our knowledge, there are no published series in the literature regarding the operative treatment of scoliosis in these patients.
We reviewed our experience with the operative treatment of scoliosis in 7 patients with a Fontan circulation. There were 7 patients identified who were treated with correction and arthrodesis using modern segmental instrumentation. A radiographic and chart review was performed to assess the operative and perioperative treatment.
Mean age at surgery was 14 years 9 months, and mean Cobb angle was 75 degrees . There were no intraoperative complications; however, postoperative complications were frequent and significant: 1 delayed paralysis, 2 superior mesenteric artery syndromes, 1 renal tubular necrosis, 2 pulmonary complications, 1 Horner syndrome, and 1 urinary tract infection.
Operative treatment of scoliosis in these patients may be successful; however, complications are frequent and significant.
对接受脊柱侧弯手术矫正的Fontan循环患者进行回顾性图表及影像学评估。
评估Fontan循环合并脊柱侧弯患者的手术及围手术期治疗情况。
复杂先天性心脏病患者的生存率正在提高，从而产生了一部分生理状况复杂且需要进行脊柱侧弯手术治疗的患者。Fontan循环是通过手术为单心室出生的患者建立的。鉴于这些患者对持续全身前负荷的生理需求，他们在脊柱手术期间存在显著的麻醉风险。目前，据我们所知，文献中尚无关于这些患者脊柱侧弯手术治疗的系列报道。
我们回顾了7例Fontan循环患者脊柱侧弯手术治疗的经验。共7例患者接受了使用现代节段性器械进行的矫正和融合手术。进行了影像学和图表回顾以评估手术及围手术期治疗情况。
手术平均年龄为14岁9个月，平均Cobb角为75度。术中无并发症；然而，术后并发症频繁且严重：1例延迟性瘫痪、2例肠系膜上动脉综合征、1例肾小管坏死、2例肺部并发症、1例霍纳综合征和1例尿路感染。
这些患者的脊柱侧弯手术治疗可能成功；然而，并发症频繁且严重。
