Ahmed Syed Imraan, Bastrom Tracey P, Yaszay Burt, Newton Peter O
Fort Belvoir Army Community Hospital, Fort Belvoir, VA.
Rady Children's Hospital, San Diego, CA.
Spine (Phila Pa 1976). 2017 Jul 1;42(13):999-1005. doi: 10.1097/BRS.0000000000001968.
An actuarial "survivorship" analysis.
The aim of this study was to define the incidence and cause of surgical revision 5 years after scoliosis surgery.
Data on contemporary revision surgery rates after idiopathic scoliosis surgery beyond the 2 years postoperatively in the adolescent and young adult population are limited.
Patients enrolled in a prospective, multicenter, idiopathic scoliosis surgical registry from 1995 to 2009 were reviewed. Any spine reoperation was defined as a "terminal event." An actuarial survivorship analysis that adjusts for patients lost to follow-up was performed to determine cumulative survival. Time intervals were defined as 0 to <3 months, 3 months to <1 year, 1 to <2 years, 2 to <5 years, and 5 to 10 years. Registry data and radiographs were reviewed and five categories for reoperation assigned: 1) implant failure and/or pseudarthrosis, 2) implant misplacement and/or prominence, 3) wound complication and/or infection, 4) residual deformity and/or progression, and 5) other.
One thousand four hundred thirty-five patients from 12 sites were included. The majority were female (80%), with major thoracic curves (76% Lenke 1-4), and average age of 15 ± 2 years (10-22) at surgery. Most had posterior spinal instrumentation and fusion (81%). At this time, 75 (5.2%) patients required reoperation. Twenty-two occurred within 3 months postop, 10 more before 1 year, 12 more before 2 years, another 20 by 5 years, and 10 more after 5 years. This corresponded to an actuarial cumulative survival of 98.3% at 3 months, 97.5% at 1 year, 96.6% at 2 years, 93.9% at 5 years, and 89.8% at the final interval (5-10 yrs).
Revisions for scoliosis continue to occur well after 2 years with a 5-year survivorship of 93.9%. Reasons for reoperation are not uniformly distributed over time, with implant-related issues and infection the leading cause for early revision, while late infection was the most common cause after 2 years. Long-term follow-up of these postoperative patients remains important.
精算“生存”分析。
本研究旨在明确脊柱侧弯手术后5年再次手术的发生率及原因。
关于青少年和青年特发性脊柱侧弯手术后2年以上当代翻修手术率的数据有限。
回顾1995年至2009年纳入前瞻性、多中心特发性脊柱侧弯手术登记处的患者。任何脊柱再次手术均定义为“终末事件”。进行了一项针对失访患者进行调整的精算生存分析，以确定累积生存率。时间间隔定义为0至<3个月、3个月至<1年、1至<2年、2至<5年以及5至10年。对登记处数据和X线片进行回顾，并将再次手术分为五类：1）植入物失败和/或假关节形成；2）植入物位置不当和/或突出；3）伤口并发症和/或感染；4）残留畸形和/或进展；5）其他。
纳入了来自12个地点的1435例患者。大多数为女性（80%），主要为胸弯（76%为Lenke 1-4型），手术时平均年龄为15±2岁（10-22岁）。大多数患者接受了后路脊柱内固定和融合术（81%）。此时，75例（5.2%）患者需要再次手术。22例发生在术后3个月内，10例在1年内，12例在2年内，另外20例在5年内，10例在5年后。这对应于3个月时的精算累积生存率为98.3%，1年时为97.5%，2年时为96.6%，5年时为93.9%，最后一个时间间隔（5-10年）时为89.8%。
脊柱侧弯手术后2年以上仍会继续出现再次手术情况，5年生存率为93.9%。再次手术的原因在不同时间分布不均，与植入物相关的问题和感染是早期再次手术的主要原因，而2年后晚期感染是最常见的原因。对这些术后患者进行长期随访仍然很重要。
3级。
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