Liang Jinqian, Ding Ran, Chua Sooyong, Li Zheng, Shen Jianxiong
Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China; and.
J Neurosurg Pediatr. 2013 Nov;12(5):505-10. doi: 10.3171/2013.8.PEDS13117. Epub 2013 Sep 13.
The safety of spinal fusion has been poorly studied in children with surgically corrected congenital cardiac malformations (CCMs). The objective of this study was to evaluate the safety of spinal fusion in patients with CCMs following cardiac surgery.
A retrospective study was conducted on 32 patients with scoliosis who received surgical treatment for their CCMs (CCM group). Sixty-four age- and sex-matched patients with scoliosis and normal hearts who received spinal fusion served as the control group. These 2 groups were compared for demographic distribution, blood loss, transfusion requirements, and incidence of postoperative complications.
The ages, curve pattern distributions, and number of levels fused were similar between the 2 groups before spinal fusion. Overall, a total of 7 patients in the CCM group (21.9%) and 5 (7.8%) in the control group had documented postoperative complications. The perioperative allogenic blood transfusion rate and mean red blood cell transfusion requirement in the CCM group were significantly higher than those found in patients in the control group (68.7% vs 28.1%, respectively, p = 0.000; and 2.68 ± 2.76 units/patient vs 0.76 ± 1.07 units/patient, respectively, p = 0.011). In the CCM group, a preoperative major curve magnitude ≥ 80° was the most accurate indicator of an increased risk for a major complication (p = 0.019), whereas no statistically significant correlation was noted between postoperative complications and age, type of congenital heart disease, operative duration, and estimated blood loss during the operation and transfusion.
Spinal fusion subsequent to prior cardiac surgery is relatively safe and effective in correcting the spinal deformity for patients with scoliosis and surgically corrected CCMs. A preoperative major curve magnitude ≥ 80° may be a risk factor in predicting postoperative complications in scoliotic patients with surgically corrected CCMs.
对于接受过手术矫正先天性心脏畸形（CCM）的儿童，脊柱融合术的安全性研究较少。本研究的目的是评估心脏手术后CCM患者进行脊柱融合术的安全性。
对32例因CCM接受手术治疗的脊柱侧弯患者（CCM组）进行回顾性研究。64例年龄和性别匹配、患有脊柱侧弯且心脏正常并接受脊柱融合术的患者作为对照组。比较这两组的人口统计学分布、失血量、输血需求和术后并发症发生率。
两组在脊柱融合术前的年龄、侧弯类型分布和融合节段数量相似。总体而言，CCM组共有7例患者（21.9%）出现术后并发症记录，对照组有5例（7.8%）。CCM组围手术期异体输血率和平均红细胞输注需求量显著高于对照组患者（分别为68.7%对28.1%，p = 0.000；以及2.68±2.76单位/患者对0.76±1.07单位/患者，p = 0.011）。在CCM组中，术前主弯角度≥80°是主要并发症风险增加的最准确指标（p = 0.019），而术后并发症与年龄、先天性心脏病类型、手术持续时间、术中估计失血量和输血之间未发现统计学上的显著相关性。
对于患有脊柱侧弯且接受过手术矫正CCM的患者，在先期心脏手术后进行脊柱融合术在矫正脊柱畸形方面相对安全有效。术前主弯角度≥80°可能是预测接受过手术矫正CCM的脊柱侧弯患者术后并发症的一个风险因素。
