Mignemi Megan, Tran Dong, Ramo Brandon, Richards B Stephens
Monroe Carell Jr. Children's Hospital at Vanderbilt, 4202 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232, USA.
Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219, USA.
Spine Deform. 2018 Jul-Aug;6(4):409-416. doi: 10.1016/j.jspd.2017.12.006.
Single-institution, retrospective review of prospectively collected data on pediatric patients with adolescent idiopathic scoliosis (AIS) undergoing spinal fusion with a minimum two-year follow-up.
To determine the rate of reoperation in AIS patients undergoing spine fusion from 2008 to 2012.
Recent trends in the surgical treatment of AIS have included increased use of all-pedicle screw constructs, smaller implants, more posterior-only approaches, and improved correction techniques.
A retrospective review of 467 patients undergoing spinal fusion from 2008 to 2012 was performed. Demographic, clinical, radiographic, and surgical data were collected prospectively on all patients for the index procedure and any reoperations. Data were compared to previously published cohorts of patients from the authors' institution who underwent spinal fusion for AIS between 1988 and 2007.
The rate of reoperation in this five-year cohort of patients was 9.9%. The most common indications for reoperation were infection (4.5%: 2.4% delayed infections and 2.1% acute infections), symptomatic implants (2.1%), and misplaced pedicle screws (1.7%). When compared to the 2003-2007 cohort, the rate of reoperation for acute infection and malpositioned pedicle screws increased significantly (p = .01 and p = .04), whereas the rate of reoperation for curve progression decreased (p = .01). Reoperations for acute infections and malpositioned pedicle screws also increased significantly (p = .047 and p = .042) compared with the 1988-2002 cohort, whereas the rate of reoperation for pseudarthrosis decreased (p = .002).
Reoperation rates for AIS have not improved with more sophisticated implants and techniques, predominantly because of increased acute infections and malpositioned pedicle screws despite decreasing pseudarthrosis rates and curve progression.
Level II.
单机构回顾性研究，对前瞻性收集的青少年特发性脊柱侧凸（AIS）儿科患者行脊柱融合术且至少随访两年的数据进行分析。
确定2008年至2012年接受脊柱融合术的AIS患者再次手术率。
AIS外科治疗的近期趋势包括全椎弓根螺钉结构的使用增加、植入物尺寸减小、更多单纯后路手术入路以及矫正技术改进。
对2008年至2012年接受脊柱融合术的467例患者进行回顾性研究。前瞻性收集所有患者初次手术及任何再次手术的人口统计学、临床、影像学和手术数据。将数据与作者所在机构先前发表的1988年至2007年间因AIS接受脊柱融合术的患者队列进行比较。
该五年患者队列的再次手术率为9.9%。再次手术最常见的指征是感染（4.5%：2.4%为延迟感染，2.1%为急性感染）、有症状的植入物（2.1%）和椎弓根螺钉位置不当（1.7%）。与2003 - 2007年队列相比，急性感染和椎弓根螺钉位置不当的再次手术率显著增加（p = 0.01和p = 0.04），而曲线进展导致的再次手术率下降（p = 0.01）。与1988 - 2002年队列相比，急性感染和椎弓根螺钉位置不当的再次手术率也显著增加（p = 0.047和p = 0.042），而假关节形成导致的再次手术率下降（p = 0.002）。
尽管假关节形成率和曲线进展率降低，但由于急性感染和椎弓根螺钉位置不当增加，更复杂的植入物和技术并未改善AIS的再次手术率。
二级。
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