*Section of Pediatric Surgery, Children's Hospital, Helsinki University Central Hospital, Helsinki †Department of Pediatric Orthopedic Surgery, Turku University Central Hospital, Turku, Finland.
J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):38-45. doi: 10.1097/MPG.0b013e3182a7dac4.
Gastrointestinal complications are frequent after surgical correction of neuromuscular scoliosis, but the effects of scoliosis surgery on gastric function and upper gastrointestinal symptoms over the long term are unknown.
Thirty-one children (16 spastic, 15 flaccid patients) who underwent surgical correction of neuromuscular scoliosis were included in a prospective follow-up study. Median (range) age at surgery was 14.9 (5-20) years and follow-up time 4.3 (2-8) years. Electrogastrography (n=28), gastric emptying scintigraphy (n=17), and structured upper gastrointestinal symptoms questionnaire (n=26) were evaluated before and after surgery. The results were related to patients' clinical state, type and extent of corrective spinal surgery, and gastrointestinal complications.
The median main scoliosis curve of 81 degrees (51-129 degrees) was corrected to 25 degrees (1.0-85 degrees) after surgery. In electrogastrogram, power ratio increased from preoperative 1.4 (0.30-11) to postoperative 6.2 (1.2-26) in the spastic group (P=0.008), whereas in the flaccid group, power ratio remained unchanged at 2.2 (0.1-17). Patients with prolonged postoperative paralytic ileus had the most substantial increase in gastric power ratio (P=0.038). Correction of sagittal spinal balance correlated with increased postprandial normogastric activity after surgery (R=0.459; P=0.004). The gastric emptying results, upper gastrointestinal symptoms, and body mass index were not significantly altered after scoliosis surgery.
Gastric myoelectrical power increased after surgical correction of spastic neuromuscular scoliosis and was associated with prolonged postoperative paralytic ileus. Correction of poor, stooped spinal balance improved gastric myoelectrical activity. The net effect of scoliosis surgery on gastric emptying, upper gastrointestinal symptoms, and clinical nutritional state was minimal.
胃肠道并发症在神经肌肉性脊柱侧凸的手术矫正后很常见，但脊柱侧凸手术对胃功能和上胃肠道症状的长期影响尚不清楚。
31 名（16 例痉挛型，15 例弛缓型）接受神经肌肉性脊柱侧凸手术矫正的患儿参与了前瞻性随访研究。手术时的中位（范围）年龄为 14.9（5-20）岁，随访时间为 4.3（2-8）年。术前和术后分别进行了胃电图（n=28）、胃排空闪烁显像（n=17）和结构性上胃肠道症状问卷（n=26）评估。结果与患者的临床状态、脊柱矫正手术的类型和程度以及胃肠道并发症相关。
81 度（51-129 度）的中位主脊柱侧凸曲线在手术后被矫正至 25 度（1.0-85 度）。在胃电图中，痉挛组的功率比从术前的 1.4（0.30-11）增加到术后的 6.2（1.2-26）（P=0.008），而弛缓组的功率比则保持在 2.2（0.1-17）不变。术后发生长时间麻痹性肠梗阻的患者胃动力比增加最显著（P=0.038）。矢状位脊柱平衡的矫正与术后餐后正常胃动力活动的增加相关（R=0.459；P=0.004）。脊柱侧凸手术后胃排空结果、上胃肠道症状和体重指数没有明显改变。
痉挛性神经肌肉性脊柱侧凸手术后胃电功率增加，与术后长时间麻痹性肠梗阻有关。不良脊柱平衡的矫正改善了胃电活动。脊柱侧凸手术对胃排空、上胃肠道症状和临床营养状态的总体影响很小。
