Qiao Jun, Xu Leilei, Liu Zhen, Zhu Feng, Qian Bangping, Sun Xu, Zhu Zezhang, Qiu Yong, Jiang Qing
Department of Spine Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
Department of Orthopedics, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, China.
Eur Spine J. 2016 Oct;25(10):3288-3293. doi: 10.1007/s00586-016-4579-0. Epub 2016 May 3.
To investigate surgical outcomes and complications of scoliosis associated with Marfan syndrome.
Inclusion criteria were patients who were 10-20 years of age, had a diagnosis of Marfan syndrome by the Ghent nosology, had scoliosis and had undergone spinal fusion, and had at least 2 years of postoperative follow-up. The medical records of all patients were reviewed for age at the time of surgery, surgical procedures performed, instrumentation type, estimated blood loss (EBL) during surgery, operation time and complications related to surgery. Health-related quality-of-life measures (obtained with the SRS-22 Questionnaire before operation and at the last clinical follow-up) were also recorded. Patients were analyzed as two different groups, Group 1 and Group 2, according to the different approaches employed. Patients receiving combined anterior and posterior surgery were assigned to Group 1 and those who received posterior-only surgery to Group 2.
Group 1 consisted of 30 patients (14 males, 16 females) with a mean age at surgery of 16.8 years (range: 10-20 years). Complications in Group 1 included two cases of instrumentation loosening with one removed, one case of instrumentation breakage and one case of chylothorax and hemothorax during video assisted thoracoscopic release. 66 patients (28 males, 38 females) with a mean age at surgery of years 16.4 years (range: 10-20 years) were included in Group 2. Complications in Group 2 included six cases of cerebro-spinal fluid leak, one case of deep wound infection secondary to cerebro-spinal fluid leak, one case of leg weakness and one case of pleural rupture cause by misplacement of pedicle screw. There is no difference of age at surgery, preoperative Cobb angles, and SRS-22 total scores (3.0 vs. 3.1) between the two groups (P > 0.05). Group 1 yielded larger correction rate than Group 2 for both thoracic (62.5 % vs. 56.2 %) and lumbar scoliosis (68.3 % vs. 62.7 %). Loss of correction was similar between the two groups for both thoracic (4.1° vs. 3.6°) and lumbar (4.2° vs. 4.6°) curves (P > 0.05). EBL (1972 ml vs. 1530) and operation time (669 min vs. 419 min) were significantly increased in Group 1 than in Group 2 (P < 0.05). No difference was noted for SRS-22 total scores in the last follow-up between the two groups (3.7 vs. 3.8, P > 0.05).
In conclusion, as compared to anterior release combined with posterior spinal fusion, posterior-only spinal fusion could yield comparable clinical outcomes for scoliosis associated with Marfan syndrome with lower EBL, and operation time. However, longer follow-up is needed to verify these findings.
探讨与马方综合征相关的脊柱侧弯的手术疗效及并发症。
纳入标准为年龄在10至20岁之间、根据根特分类法诊断为马方综合征、患有脊柱侧弯并接受了脊柱融合术且术后至少随访2年的患者。查阅所有患者的病历，记录手术时的年龄、所施行的手术操作、内固定类型、手术期间估计失血量（EBL）、手术时间以及与手术相关的并发症。还记录了与健康相关的生活质量指标（术前及最后一次临床随访时通过SRS - 22问卷获得）。根据所采用的不同手术方式，将患者分为两组，即第1组和第2组。接受前后联合手术的患者被分配到第1组，仅接受后路手术的患者被分配到第2组。
第1组由30例患者（14例男性，16例女性）组成，手术时的平均年龄为16.8岁（范围：10至20岁）。第1组的并发症包括2例内固定松动，其中1例取出，1例内固定断裂，以及1例在电视辅助胸腔镜松解过程中出现乳糜胸和血胸。第2组包括66例患者（28例男性，38例女性），手术时的平均年龄为16.4岁（范围：10至20岁）。第2组的并发症包括6例脑脊液漏，1例因脑脊液漏继发的深部伤口感染，1例腿部无力，以及1例因椎弓根螺钉置入不当导致的胸膜破裂。两组之间手术时的年龄、术前Cobb角和SRS - 22总分（3.0对3.1）无差异（P>0.05）。对于胸椎（62.5%对56.2%）和腰椎脊柱侧弯（68.3%对62.7%），第1组的矫正率均高于第2组。两组之间胸椎（4.1°对3.6°）和腰椎（4.2°对4.6°）曲线的矫正丢失情况相似（P>0.05）。第1组的EBL（1972毫升对1530毫升）和手术时间（669分钟对419分钟）明显高于第2组（P<0.05）。两组在最后一次随访时的SRS - 22总分无差异（3.7对3.8，P>0.05）。
总之，与前路松解联合后路脊柱融合相比，仅后路脊柱融合对于与马方综合征相关的脊柱侧弯可产生相当的临床疗效，且EBL和手术时间更低。然而，需要更长时间的随访来验证这些发现。
