20 年来青少年特发性脊柱侧凸手术治疗的演变：疗效是否得到改善？
Evolution of Surgery for Adolescent Idiopathic Scoliosis Over 20 Years: Have Outcomes Improved?
机构信息
Mount Sinai Hospital, New York, NY.
Rady Children's Hospital San Diego, San Diego, CA.
出版信息
Spine (Phila Pa 1976). 2018 Mar 15;43(6):402-410. doi: 10.1097/BRS.0000000000002332.
STUDY DESIGN
Retrospective review of a prospective adolescent idiopathic scoliosis (AIS) registry.
OBJECTIVE
To study the evolution of the operative approach, outcomes, and complication rates in AIS surgery over the past 20 years.
SUMMARY OF BACKGROUND DATA
Surgical techniques in AIS surgery have evolved considerably over the past 20 years. We study the trends in the operative management of AIS over this period and their impact on perioperative outcomes.
METHODS
A total of 1819 AIS patients (1995-2013) with 2-year F/U were studied. Operative approach, perioperative parameters, major complication rates, and SRS outcomes were assessed. Linear regression was used to assess the trend of changes over 5-year quartiles.
RESULTS
Mean age at surgery was 14.6 ± 2.1 years, 80.2% were females, and this remained consistent throughout. Operative time, EBL/level, and LOS decreased over the 20 years (P < 0.0001). The use of antifibrinolytic (AF) increased from 6.7% to 68.8% in the past 10 years (P < 0.0001). Number of levels fused increased and LIV was more distal (in relation to stable vertebrae) over time in Lenke 1 and 2 curves (levels fused 7.97-9.94, P < 0.0001 and 9.8-11.0, P=0.0134, respectively). Anterior spinal fusion (ASF) in Lenke 1 curves decreased from 81% in the first quartile to 0% in the last (P = 0.0429). ASF for Lenke 5 curves evolved from 78% in the second quartile to 0 in the last. Thoracoplasty performance decreased from 76% to 20.3% (P = 0.1632). All screw constructs in PSF cases increased from 0% to 98.4% (P = 0.0095). Two-year major complication rates decreased over time (18.7%-5.1%; P = 0.0173). Increased improvement in SRS scores were observed in pain, image, function, and total domains.
CONCLUSION
Evolution of surgical technique in AIS over the past 20 years has resulted in a cessation of anterior only surgery, increasing use of all screw constructs, less blood loss, greater use of AF, shorter operative times and LOS, lower major complications rates, and greater improvements in SRS scores.
LEVEL OF EVIDENCE
研究设计
前瞻性青少年特发性脊柱侧凸（AIS）登记处的回顾性研究。
目的
研究过去 20 年来 AIS 手术中手术方法、结果和并发症发生率的演变。
背景资料概要
AIS 手术中的手术技术在过去 20 年中发生了很大变化。我们研究了在此期间 AIS 手术管理的趋势及其对围手术期结果的影响。
方法
共研究了 1819 例 AIS 患者（1995-2013 年），并进行了 2 年的随访。评估了手术方法、围手术期参数、主要并发症发生率和 SRS 结果。线性回归用于评估 5 年四分位数期间的变化趋势。
结果
手术时的平均年龄为 14.6±2.1 岁，80.2%为女性，且一直保持不变。20 年来，手术时间、出血量/节段和住院时间均有所减少（P<0.0001）。抗纤维蛋白溶解剂（AF）的使用从最初的 6.7%增加到过去 10 年的 68.8%（P<0.0001）。在 Lenke 1 和 2 型曲线中，融合的节段数增加，并且 LIV 更靠近（相对于稳定的椎骨）（融合的节段数 7.97-9.94，P<0.0001 和 9.8-11.0，P=0.0134）。Lenke 1 型曲线中前侧脊柱融合（ASF）的比例从第一四分位数的 81%降至最后一个四分位数的 0%（P=0.0429）。Lenke 5 型曲线的 ASF 从第二四分位数的 78%演变为最后一个四分位数的 0%。胸廓成形术的比例从 76%降至 20.3%（P=0.1632）。所有 PSF 病例的螺钉结构均从 0%增加到 98.4%（P=0.0095）。2 年主要并发症发生率随时间的推移而降低（18.7%-5.1%；P=0.0173）。SRS 评分在疼痛、影像、功能和总分方面的改善更为明显。
结论
过去 20 年来 AIS 手术技术的演变导致了前侧手术的停止，全螺钉结构的使用增加，出血量减少，AF 的使用增加，手术时间和住院时间缩短，主要并发症发生率降低，SRS 评分提高。
证据水平
2 级。
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