休曼氏病后凸畸形手术的并发症：其陷阱与青少年特发性脊柱侧凸手术的有何不同？
Complications in operative Scheuermann kyphosis: do the pitfalls differ from operative adolescent idiopathic scoliosis?
作者信息
Lonner Baron S, Toombs Courtney S, Guss Michael, Braaksma Brian, Shah Suken A, Samdani Amer, Shufflebarger Harry, Sponseller Paul, Newton Peter O
机构信息
*Mount Sinai Medical Center, Beth Israel Hospital, New York, NY †New York University Hospital for Joint Diseases, New York, NY ‡Alfred I. duPont Hospital for Children, Wilmington, DE §Shriners Hospital for Children, Philadelphia, PA ¶Miami Children's Hospital, Miami, FL ∥Johns Hopkins Hospital, Baltimore, MD; and **Rady Children's Hospital San Diego, San Diego, CA.
出版信息
Spine (Phila Pa 1976). 2015 Mar 1;40(5):305-11. doi: 10.1097/BRS.0000000000000757.
STUDY DESIGN
A prospective multicenter database of operative patients with Scheuermann kyphosis (SK) with minimum 1-year follow-up was studied for major complications compared with contemporaneous operative patients with adolescent idiopathic scoliosis (AIS) from the database.
OBJECTIVE
To evaluate complications associated with current surgical techniques in SK and AIS.
SUMMARY OF BACKGROUND DATA
There is a paucity of literature regarding complications associated with SK surgical treatment, but prior data suggest an elevated neurological risk.
METHODS
Complication rates were compared using analysis of variance and Fisher exact test analyses. Major complications were those that were life-threatening, caused spinal cord, nerve root, or ocular injury or required reoperation including surgical site infections. A binary logistic regression determined the likelihood of complications based on diagnosis, levels fused, blood loss, operative time, and length of stay.
RESULTS
Ninety-seven patients with SK (57 males; mean age, 16.5 yr; 75.3° mean kyphosis) and 800 patients with AIS (622 females; mean age, 14.9 yr; 55.6° mean curvature) met inclusion criteria. Patients with SK had significantly more major complications than those with AIS (16.3% vs. 2.3%; P < 0.001). The SK group had more infections (10.3% vs. 0.75%) and reoperations (14.4% vs. 1.4%) (P < 0.001). Operative time was longer and more levels were fused in the SK group (P < 0.001). Surgical site infection was the most common complication. There were no significant differences in length of stay or blood loss. Patients with SK were 3.9× more likely to have a major complication than those with AIS (odds ratio: 0.26, P = 0.003). The number of levels fused was an independent predictor of major complications: each additional level fused increased the odds of a complication by 36% in both groups (odds ratio: 1.36, P = 0.034).
CONCLUSION
Major complications are 3.9× more likely to occur in operative SK than in AIS. The number of levels fused is an independent risk factor for major complications. Patients with SK are at higher risk for infections and reoperation than those with AIS.
LEVEL OF EVIDENCE
研究设计
对Scheuermann驼背（SK）手术患者的前瞻性多中心数据库进行研究，这些患者至少随访1年，将其主要并发症与数据库中同期青少年特发性脊柱侧凸（AIS）手术患者进行比较。
目的
评估SK和AIS当前手术技术相关的并发症。
背景数据总结
关于SK手术治疗相关并发症的文献较少，但既往数据提示神经风险升高。
方法
采用方差分析和Fisher精确检验分析比较并发症发生率。主要并发症是指危及生命、导致脊髓、神经根或眼部损伤或需要再次手术（包括手术部位感染）的并发症。二元逻辑回归根据诊断、融合节段、失血量、手术时间和住院时间确定并发症发生的可能性。
结果
97例SK患者（57例男性；平均年龄16.5岁；平均驼背75.3°）和800例AIS患者（622例女性；平均年龄14.9岁；平均侧弯55.6°）符合纳入标准。SK患者的主要并发症明显多于AIS患者（16.3%对2.3%；P<0.001）。SK组感染（10.3%对0.75%）和再次手术（14.4%对1.4%）更多（P<0.001）。SK组手术时间更长，融合节段更多（P<0.001）。手术部位感染是最常见的并发症。住院时间和失血量无显著差异。SK患者发生主要并发症的可能性是AIS患者的3.9倍（比值比：0.26，P = 0.003）。融合节段数是主要并发症独立的预测因素：两组中每增加一个融合节段，并发症发生几率增加36%（比值比：1.36，P = 0.034）。
结论
SK手术患者发生主要并发症的可能性是AIS患者的3.9倍。融合节段数是主要并发症的独立危险因素。与AIS患者相比，SK患者发生感染和再次手术的风险更高。
证据级别
2级
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