脑瘫脊柱侧凸的手术入路及疗效相关因素。
Factors associated with surgical approach and outcomes in cerebral palsy scoliosis.
机构信息
Division of Orthopedics, The Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
, San Diego, CA, USA.
出版信息
Eur Spine J. 2019 Mar;28(3):567-580. doi: 10.1007/s00586-018-5745-3. Epub 2018 Aug 24.
BACKGROUND
Neuromuscular scoliosis is often treated with posterior spinal fusion, with or without anterior release, and either a same-day or staged, 2-day procedure.
METHODS
We retrospectively reviewed 222 patients from a prospectively collected, multi-center database of patients with cerebral palsy scoliosis with 2-year follow-up. Baseline characteristics, perioperative, radiographic, and HRQoL measures were compared in six sub-analyses: (1) staged versus same-day surgeries, (2) posterior-only fusion (PSF) versus anterior-posterior spinal fusion (APSF), (3) same-day versus staged PSF, (4) staged versus same-day APSF, (5) same-day PSF versus same-day APSF, (6) staged PSF versus staged APSF.
RESULTS
Staged patients had larger curves and more pelvic obliquity, longer anesthesia and surgical times, longer hospital and ICU stays (p < 0.001), and more days intubated (p = 0.021). The staged PSF group had larger curves (p = 0.006), longer anesthesia (p = 0.020) and surgeries (p = 0.007), hospital (p = 0.009) and ICU stays (p = 0.028) compared to same-day PSF. The staged APSF group had longer hospital (p < 0.001) and ICU stays (p = 0.004) and anesthesia and surgeries (p < 0.001). Same-day APSF was associated with larger curves (p < 0.002), longer anesthesia (p = 0.012) and surgeries (p = 0.042), greater residual curves (p = 0.035), and greater absolute correction (p = 0.007) compared to same-day PSF. The staged APSF group had longer anesthesia times (p < 0.001) compared to the staged PSF group. No sub-analysis revealed significant differences in baseline characteristics, complications, or HRQoL.
CONCLUSION
Staged and circumferential approaches tend to be used for greater deformity, but were not associated with superior deformity correction, and were associated with longer operative time, hospital stays, ICU stays, and days intubated. However, for the most severe deformity, other patient factors may play more important roles in treatment decisions given that patients treated with a staged PSF or an APSF, whether staged or not, were similar at baseline.
LEVEL OF EVIDENCE
III. These slides can be retrieved under Electronic Supplementary Material.
背景
神经肌肉性脊柱侧凸常采用后路脊柱融合术治疗，可合并或不合并前路松解，采用同日或分期、2 天手术。
方法
我们回顾性分析了前瞻性收集的脑瘫脊柱侧凸患者多中心数据库中的 222 例患者，随访时间为 2 年。在 6 个亚分析中比较了基线特征、围手术期、影像学和 HRQoL 测量结果：（1）分期手术与同日手术，（2）后路单纯融合术（PSF）与前后路脊柱融合术（APSF），（3）同日 PSF 与分期 PSF，（4）分期 APSF 与同日 APSF，（5）同日 PSF 与同日 APSF，（6）分期 PSF 与分期 APSF。
结果
分期手术患者的曲线更大，骨盆倾斜更明显，麻醉和手术时间更长，住院和 ICU 时间更长（p<0.001），插管天数更多（p=0.021）。分期 PSF 组的曲线更大（p=0.006），麻醉时间（p=0.020）和手术时间（p=0.007）、住院时间（p=0.009）和 ICU 时间（p=0.028）均长于同日 PSF 组。分期 APSF 组的住院时间（p<0.001）和 ICU 时间（p=0.004）以及麻醉和手术时间（p<0.001）均长于同日 APSF 组。同日 APSF 组的曲线更大（p<0.002），麻醉时间（p=0.012）和手术时间（p=0.042）、残余曲线更大（p=0.035）、绝对矫正更大（p=0.007），均长于同日 PSF 组。分期 APSF 组的麻醉时间长于分期 PSF 组（p<0.001）。没有亚分析显示基线特征、并发症或 HRQoL 有显著差异。
结论
分期和环形手术方法倾向于用于治疗更大的畸形，但与更好的畸形矫正无关，与手术时间延长、住院时间、ICU 时间和插管天数增加有关。然而，对于最严重的畸形，由于接受分期 PSF 或 APSF 治疗的患者（无论分期与否）的基线特征相似，其他患者因素可能在治疗决策中发挥更重要的作用。
证据水平
III. 这些幻灯片可以在电子补充材料中检索。
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