Smith John T, Smith Melissa S
Department of Orthopaedics, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, UT.
J Pediatr Orthop. 2013 Dec;33(8):e69-71. doi: 10.1097/BPO.0b013e318296e032.
Constipation is a common problem after surgery for adolescent idiopathic scoliosis (AIS), with bowel morbidity being reported as high as 78%. The purpose of this study was to determine if a preoperative bowel preparation reduces the incidence of bowel morbidity after surgery for AIS.
This is an IRB-approved randomized, prospective study of 60 consecutive patients who underwent surgery for AIS. After consent to participate was signed by the patients' family, patients were randomized to either a preoperative bowel preparation (group A) or no bowel preparation (group B). Bowel morbidity data were then collected and compared postoperatively.
Complete data were available for 27 patients in group A and 28 in group B. Postoperatively, we found that group A had less weight gain (P<0.09), fewer postoperative bowel medications (P<0.023), and a shorter time to first bowel movement (P<0.03) when compared with group B. Two patients in group B had persistent constipation after discharge, one requiring readmission to the hospital. One patient in group B developed a postoperative wound infection. There were no adverse events in group A postoperatively.
This study did show a modest reduction in some aspects of bowel morbidity when patients had a preoperative bowel preparation before scoliosis surgery. However, these differences did not reach statistical significance. Therefore, we do not recommend routine preoperative bowel preparations for AIS patients.
Level II.
便秘是青少年特发性脊柱侧凸（AIS）手术后的常见问题，据报道肠道发病率高达78%。本研究的目的是确定术前肠道准备是否能降低AIS手术后肠道发病的发生率。
这是一项经机构审查委员会批准的前瞻性随机研究，连续纳入60例行AIS手术的患者。在患者家属签署参与同意书后，将患者随机分为术前肠道准备组（A组）或无肠道准备组（B组）。然后收集术后肠道发病数据并进行比较。
A组27例患者和B组28例患者有完整数据。术后，我们发现与B组相比，A组体重增加较少（P<0.09），术后使用的肠道药物较少（P<0.023），首次排便时间较短（P<0.03）。B组有2例患者出院后持续便秘，其中1例需要再次入院。B组有1例患者发生术后伤口感染。A组术后无不良事件发生。
本研究确实表明，脊柱侧凸手术前进行肠道准备的患者在肠道发病的某些方面有适度降低。然而，这些差异未达到统计学意义。因此，我们不建议对AIS患者进行常规术前肠道准备。
二级。
