青少年特发性脊柱侧弯中的肥胖是否与更大的侧弯度数及更差的手术效果相关？
Is Obesity in Adolescent Idiopathic Scoliosis Associated With Larger Curves and Worse Surgical Outcomes?
作者信息
Li Ying, Binkowski Laura, Grzywna Alexandra, Robbins Christopher B, Caird Michelle S, Farley Frances A, Glotzbecker Michael
机构信息
Department of Orthopedic Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Boston Children's Hospital, Boston, MA.
出版信息
Spine (Phila Pa 1976). 2017 Feb;42(3):E156-E162. doi: 10.1097/BRS.0000000000001721.
STUDY DESIGN
A multicenter retrospective study of preoperative characteristics and surgical outcomes in adolescent idiopathic scoliosis (AIS).
OBJECTIVE
To determine the effect of obesity on (i) curve magnitude at first presentation to an orthopedic surgeon, and (ii) surgical outcomes.
SUMMARY OF BACKGROUND DATA
Clinical findings for scoliosis may be less apparent in overweight adolescents. The effect of obesity on curve magnitude at presentation to an orthopedic surgeon has not been studied. It is unclear whether obesity is associated with worse surgical outcomes in AIS.
METHODS
Demographic, radiographic, perioperative, and complications data were collected on AIS patients who had undergone posterior spinal fusion (PSF). Descriptive and inferential analyses were conducted to compare healthy-weight (HW) [body mass index percentile for age (BMI%) ≤ 84], overweight (OW; BMI% ≥ 85), and obese (OB; BMI% ≥ 95) adolescents.
RESULTS
We analyzed 588 patients (454 HW, 134 OW, and 71 OB). In comparison with the HW adolescents, major curve magnitude at presentation to orthopedics was larger in the OW adolescents (49.3° vs. 43.9°) (P < 0.0001) and OB adolescents (50.4° vs. 43.9°) (P = 0.001). The OW and OB groups had increased preoperative major curve magnitude [(59.1° vs. 55.4°) (P = 0.001); (59.9° vs. 55.4°) (P = 0.001)], preoperative minor curve magnitude [(42.2° vs. 37.2°) (P < 0.0001); (43.0° vs. 37.2°) (P = 0.001)], preoperative thoracic kyphosis [(30.8° vs. 25.7°) (P < 0.0001); (33.7° vs. 25.7°) (P < 0.0001)], and surgical time [(307 vs. 276 mins) (P = 0.009); (320 vs. 276 mins) (P = 0.005)] than the HW group.Subgroup analysis of the patients with a minimum 2-year follow-up (n = 245) showed a trend towards a higher complication rate in the OB group (47.8% vs. 28.3%) (P = 0.054). The OB group had significantly more superficial infections than the HW group (13.0% vs. 1.6%) (P = 0.001).
CONCLUSION
OW patients with AIS have a larger curve magnitude at presentation to an orthopedic surgeon. OW patients who undergo PSF for AIS have increased surgical times. OB patients may be at higher risk of postoperative complications.
LEVEL OF EVIDENCE
研究设计
一项关于青少年特发性脊柱侧凸（AIS）术前特征和手术结果的多中心回顾性研究。
目的
确定肥胖对（i）初次就诊于骨科医生时的侧弯度数，以及（ii）手术结果的影响。
背景数据总结
脊柱侧凸的临床症状在超重青少年中可能不太明显。肥胖对初次就诊于骨科医生时侧弯度数的影响尚未得到研究。目前尚不清楚肥胖是否与AIS患者更差的手术结果相关。
方法
收集接受后路脊柱融合术（PSF）的AIS患者的人口统计学、影像学、围手术期和并发症数据。进行描述性和推断性分析，以比较正常体重（HW）[年龄别体重指数百分位数（BMI%）≤84]、超重（OW；BMI%≥85）和肥胖（OB；BMI%≥95）青少年。
结果
我们分析了588例患者（454例HW，134例OW，71例OB）。与HW青少年相比，OW青少年初次就诊于骨科时的主弯度数更大（49.3°对43.9°）（P<0.0001），OB青少年也是如此（50.4°对43.9°）（P = 0.001）。OW组和OB组术前主弯度数增加[（59.1°对55.4°）（P = 0.001）；（59.9°对55.4°）（P = 0.001）]，术前次弯度数增加[（42.2°对37.2°）（P<0.0001）；（43.0°对37.2°）（P = 0.001）]，术前胸椎后凸增加[（30.8°对25.7°）（P<0.0001）；（33.7°对25.7°）（P<0.0001）]，手术时间也更长[（307对276分钟）（P = 0.009）；（320对276分钟）（P = 0.005）]。对至少随访2年的患者（n = 245）进行亚组分析显示，OB组有并发症发生率更高的趋势（47.8%对28.3%）（P = 0.054）。OB组浅表感染明显多于HW组（13.0%对1.6%）（P = 0.001）。
结论
患有AIS的OW患者初次就诊于骨科医生时侧弯度数更大。因AIS接受PSF的OW患者手术时间增加。OB患者术后并发症风险可能更高。
证据级别
3级。
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