尽管使用巴氯芬泵不方便，但它并不会使脑瘫患者的脊柱侧弯手术变得复杂。
Although inconvenient, baclofen pumps do not complicate scoliosis surgery in patients with cerebral palsy.
作者信息
Yaszay Burt, Scannell Brian P, Bomar James D, Sponseller Paul D, Shah Suken A, Asghar Jahangir, Samdani Amer F, Bastrom Tracey P, Newton Peter O
机构信息
*Rady Children's Hospital, San Diego, CA †Carolinas Medical Center, Charlotte, NC ‡The Johns Hopkins Hospital, Baltimore, MD §Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE ¶Miami Children's Hospital, Miami, FL ‖Shriners Hospitals for Children, Philadelphia, PA; and **Setting Scoliosis Straight Foundation, San Diego, CA.
出版信息
Spine (Phila Pa 1976). 2015 Apr 15;40(8):E504-9. doi: 10.1097/BRS.0000000000000811.
STUDY DESIGN
Retrospective review of prospectively collected data.
OBJECTIVE
To compare patients with operative cerebral palsy with and without an intrathecal baclofen pump (ITB) to determine whether an ITB increases the complexity of scoliosis surgery and/or increases the risk of wound complications.
SUMMARY OF BACKGROUND DATA
Options for baclofen pump placement include before, during, or after scoliosis surgery. There is some concern that prior placement of an ITB and catheter can further complicate cerebral palsy scoliosis surgery and increase the risk for wound complications.
METHODS
Prospectively collected cases from a multicenter cerebral palsy scoliosis database were reviewed for patients who underwent posterior spinal instrumentation and fusion for a major coronal deformity. These patients were then divided on the basis of whether they had ITB at the time of initial scoliosis surgery. The 2 groups were compared to determine differences in demographics, operative parameters, radiographical outcomes, and rates of wound complications.
RESULTS
Of 187 patients identified, 32 had an ITB previously placed (ITB group) and 155 did not (non-ITB group). Both groups were similar in regard to age, sex, Gross Motor Function Classification Scale score, and preoperative Cobb magnitude. When comparing operative parameters, there were no differences in the total operating room time (ITB = 375 ± 127 min, non-ITB = 423 ± 178 min; P = 0.149) or total estimated blood loss (ITB = 2323 ± 1489 mL, non-ITB = 2081 ± 1572 mL; P = 0.424). Postoperatively, the 2 groups had similar correction rates (71% vs. 67%, P = 0.303). As for perioperative wound complications, there were no differences in rates (P = 0.546) between the ITB (16%) and non-ITB group (15%).
CONCLUSION
Although it may be inconvenient for the surgeon, ITBs do not increase the complexity of surgery or the risk for wound complications. When counseling patients and their caregivers on the timing of pump placement, it does not seem to compromise the care of the patient if the baclofen pump is placed first. Further study is needed to evaluate the safety of pump placement during or after scoliosis surgery.
LEVEL OF EVIDENCE
研究设计
对前瞻性收集的数据进行回顾性分析。
目的
比较接受鞘内注射巴氯芬泵（ITB）和未接受ITB的痉挛性脑瘫患者，以确定ITB是否会增加脊柱侧弯手术的复杂性和/或增加伤口并发症的风险。
背景资料总结
巴氯芬泵植入的时机选择包括在脊柱侧弯手术前、手术中或手术后。有人担心，预先植入ITB和导管会使痉挛性脑瘫脊柱侧弯手术更加复杂，并增加伤口并发症的风险。
方法
回顾多中心痉挛性脑瘫脊柱侧弯数据库中前瞻性收集的病例，这些患者因主要冠状面畸形接受了后路脊柱内固定融合术。然后根据患者在初次脊柱侧弯手术时是否有ITB将这些患者分组。比较两组患者的人口统计学、手术参数、影像学结果和伤口并发症发生率的差异。
结果
在187例患者中，32例先前已植入ITB（ITB组），155例未植入（非ITB组）。两组在年龄、性别、粗大运动功能分级量表评分和术前Cobb角大小方面相似。比较手术参数时，总手术时间（ITB组=375±127分钟，非ITB组=423±178分钟；P=0.149）或总估计失血量（ITB组=2323±1489毫升，非ITB组=2081±1572毫升；P=0.424）无差异。术后，两组的矫正率相似（71%对67%，P=0.303）。至于围手术期伤口并发症，ITB组（16%）和非ITB组（15%）的发生率无差异（P=0.546）。
结论
虽然对手术医生来说可能不方便，但ITB不会增加手术复杂性或伤口并发症风险。在向患者及其护理人员咨询泵植入时机时，如果先植入巴氯芬泵，似乎不会影响患者的治疗。需要进一步研究以评估脊柱侧弯手术期间或之后植入泵的安全性。
证据级别
4级。
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