Kaito Takashi, Shimada Masatoshi, Ichikawa Hajime, Makino Takahiro, Takenaka Shota, Sakai Yusuke, Yoshikawa Hideki, Hoashi Takaya
Department of Orthopedic Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Japan.
JB JS Open Access. 2018 Mar 12;3(1):e0045. doi: 10.2106/JBJS.OA.17.00045. eCollection 2018 Mar 29.
The surgical treatment of congenital heart disease is reported to be associated with a high prevalence of scoliosis, although the detailed etiology is unknown. Surgical interventions involving the rib cage are considered to increase the risk of scoliosis. However, whether the cardiac condition or the procedure performed makes patients more susceptible to the development of spinal deformity is controversial.
The present study included 483 patients who underwent surgery for the treatment of congenital heart disease with use of procedures involving the immature rib cage (sternotomy and/or thoracotomy) during the first year of life, followed by the evaluation of standing chest radiographs at ≥10 years of age. Patients with congenital spinal deformity and potential neuromuscular disease were excluded. The prevalence of and predictive factors for scoliosis were evaluated. The presence of scoliosis (Cobb angle ≥10° to <20°, ≥20° to <30°, ≥30° to <45°, ≥45°), the convex side of the curve, and the location of the curve were evaluated radiographically. Potential predictive factors that were analyzed included the age at the time of surgery, surgical approach, use of cardiopulmonary bypass, postoperative heart failure and/or cyanosis, New York Heart Association (NYHA) class, cardiomegaly, and age at the time of radiography.
The mean age at the time of surgery was 112 days, and the mean age at the time of radiography was 14.4 years. The prevalence of scoliosis was 42.4%, and the prevalences of ≥10° to <20°, ≥20° to <30°, ≥30° to <45°, and ≥45° scoliosis were 31.7%, 5.8%, 2.5%, and 2.5%, respectively. Three patients underwent surgery for the treatment of progressive scoliosis. Multivariate analysis indicated that the predictive factors were female sex, left thoracotomy, bilateral thoracotomy, NYHA class, and age at the time of radiography for ≥10° scoliosis; cardiomegaly, NYHA class, and age at the time of radiography for ≥20° scoliosis; cardiomegaly, number of surgical procedures, and age at the time of radiography for ≥30° scoliosis; and cardiomegaly for ≥45° scoliosis. Age at the time of radiography was a predictor of <45° scoliosis; however, the relative association was small.
Surgery for the treatment of congenital heart disease during the first year of life was associated with a high prevalence of scoliosis (≥40%). While female sex was one of several predictors of ≥10° scoliosis, cardiomegaly was the sole predictor of ≥45° scoliosis.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
据报道，先天性心脏病的外科治疗与脊柱侧弯的高患病率相关，尽管其具体病因尚不清楚。涉及胸廓的外科手术被认为会增加脊柱侧弯的风险。然而，是心脏状况还是所施行的手术使患者更易发生脊柱畸形仍存在争议。
本研究纳入了483例在出生后第一年内接受先天性心脏病手术治疗且手术涉及未成熟胸廓（胸骨切开术和/或开胸术）的患者，随后在≥10岁时对站立位胸部X线片进行评估。排除患有先天性脊柱畸形和潜在神经肌肉疾病的患者。评估脊柱侧弯的患病率及预测因素。通过X线片评估脊柱侧弯（Cobb角≥10°至<20°、≥20°至<30°、≥30°至<45°、≥45°）的存在情况、侧弯的凸侧以及侧弯的位置。分析的潜在预测因素包括手术时的年龄、手术入路、体外循环的使用、术后心力衰竭和/或发绀、纽约心脏协会（NYHA）心功能分级、心脏扩大以及X线检查时的年龄。
手术时的平均年龄为112天，X线检查时的平均年龄为14.4岁。脊柱侧弯的患病率为42.4%，Cobb角≥10°至<20°、≥20°至<30°、≥30°至<45°和≥45°的脊柱侧弯患病率分别为31.7%、5.8%、2.5%和2.5%。3例患者接受了进行性脊柱侧弯的手术治疗。多因素分析表明，对于Cobb角≥10°的脊柱侧弯，预测因素为女性、左开胸术、双侧开胸术、NYHA心功能分级以及X线检查时的年龄；对于Cobb角≥20°的脊柱侧弯，预测因素为心脏扩大、NYHA心功能分级以及X线检查时的年龄；对于Cobb角≥30°的脊柱侧弯，预测因素为心脏扩大、手术次数以及X线检查时的年龄；对于Cobb角≥45°的脊柱侧弯，预测因素为心脏扩大。X线检查时的年龄是Cobb角<45°脊柱侧弯的一个预测因素；然而，其相对关联较小。
出生后第一年内进行的先天性心脏病手术与脊柱侧弯的高患病率（≥40%）相关。虽然女性是Cobb角≥10°脊柱侧弯的几个预测因素之一，但心脏扩大是Cobb角≥45°脊柱侧弯的唯一预测因素。
预后IV级。有关证据水平的完整描述，请参阅《作者须知》。
