Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Spine (Phila Pa 1976). 2012 Jun 15;37(14):1198-210. doi: 10.1097/BRS.0b013e31824fffde.
A retrospective review.
To characterize the risk factors for the development of major complications in 3-column osteotomies and determine whether the presence of a major complication affects ultimate clinical outcomes.
Three-column spinal osteotomies, including pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR), are common techniques to correct severe and/or rigid spinal deformities.
Two hundred forty consecutive PSO (n = 156) and VCR (n = 84) procedures in 237 patients were performed at a single institution between 1995 and 2008. Of these, 105 patients (87 PSOs, 18 VCRs) had complete preoperative and minimum 2-year postoperative clinical outcomes data available for analysis. Using established criteria, we reported complications as major or minor and further stratified complications as surgical versus medical and permanent versus transient. Risk factors for complications and their effect on Scoliosis Research Society (SRS) clinical outcomes at baseline and at 2 years or more were assessed.
Major medical and surgical complications occurred at similar rates in both PSOs and VCRs (38%, 33 of 87 vs. 22%, 4 of 18; P = 0.28). Overall, 24.8% (26 of 105) experienced major surgical complications (3 permanent) and 15.2% (16 of 105) experienced major medical complications (4 permanent). Patients with PSO were older (53 vs. 29 yr; P < 0.001), had greater estimated blood loss (1867 vs. 1278 mL; P = 0.02), and showed a trend toward fewer fused levels (10.1 vs. 12.2; P = 0.06). Risk factors for major complications included preoperative sagittal imbalance of 40 mm or more (P = 0.01), age 60 years and older (P = 0.01), and the presence of 3 or more medical comorbidities (P = 0.04). Both groups improved significantly from baseline in SRS subscores; however, patients with PSO started off worse but improved more than VCRs in both the pain (+1.0 vs. +0.1; P < 0.001) and function (+0.6 vs. +0.2; P = 0.01) domains, with no differences in final satisfaction (4.1 vs. 4.3; P = 0.54). PSO and VCR patients with no complications had slightly higher satisfaction scores than patients with minor-only complications, major transient complications, and major permanent complications. There were no significant differences among the groups with respect to change in SRS subscores from baseline, and all complication groups improved significantly from baseline (P = 0.04).
Major complications occurred in 35% of 3-column osteotomies and at similar rates for both PSO (38%) and VCR (22%) procedures. The presence of a major complication did not affect the ultimate clinical outcomes at 2 years or more.
回顾性研究。
分析三柱截骨术主要并发症的危险因素，并确定主要并发症的发生是否影响最终的临床结果。
三柱脊柱截骨术，包括经关节突截骨术（PSO）和脊柱全长切除术（VCR），是矫正严重和/或僵硬脊柱畸形的常用技术。
在一家机构中，1995 年至 2008 年期间对 237 例患者进行了 240 例连续 PSO（n=156）和 VCR（n=84）手术。其中，105 例患者（87 例 PSO，18 例 VCR）具有完整的术前和至少 2 年的术后临床结局数据。我们使用既定标准报告并发症为主要或次要，并进一步将并发症分为手术和医疗以及永久性和暂时性。评估了并发症的危险因素及其对 SRS 临床结果基线和 2 年或更长时间的影响。
PSO 和 VCR 的主要医疗和手术并发症发生率相似（38%，33/87 例与 22%，4/18 例；P=0.28）。总体而言，24.8%（26/105）发生了主要手术并发症（3 例永久性），15.2%（16/105）发生了主要医疗并发症（4 例永久性）。PSO 患者年龄较大（53 岁与 29 岁；P<0.001），估计失血量较多（1867 毫升与 1278 毫升；P=0.02），融合节段数较少的趋势（10.1 与 12.2；P=0.06）。主要并发症的危险因素包括术前矢状面失衡 40 毫米或以上（P=0.01）、年龄 60 岁及以上（P=0.01）以及存在 3 种或更多种合并症（P=0.04）。两组患者的 SRS 亚评分均从基线显著改善；然而，PSO 组的起始评分较差，但在疼痛（+1.0 与+0.1；P<0.001）和功能（+0.6 与+0.2；P=0.01）领域的改善程度均高于 VCR 组，最终满意度无差异（4.1 与 4.3；P=0.54）。无并发症的 PSO 和 VCR 患者的满意度评分略高于仅有轻微并发症、主要短暂性并发症和主要永久性并发症的患者。各组之间在 SRS 亚评分的基线变化方面没有显著差异，所有并发症组均从基线显著改善（P=0.04）。
三柱截骨术的主要并发症发生率为 35%，PSO（38%）和 VCR（22%）手术的发生率相似。主要并发症的存在并不影响 2 年或更长时间的最终临床结果。
