Grabala Pawel, Helenius Ilkka, Buchowski Jacob M, Larson Annalise Noelle, Shah Suken A
Department of Pediatric Orthopaedics and Traumatology, Faculty of Medicine, Medical University of Bialystok, Bialystok, Poland; Department of Pediatric Orthopaedic with Scoliosis Service, Regional Specialized Children's Hospital, Olsztyn, Poland.
Department of Paediatric Orthopaedic Surgery, University of Turku and Turku University Hospital, Turku, Finland.
World Neurosurg. 2019 Apr;124:e404-e410. doi: 10.1016/j.wneu.2018.12.106. Epub 2019 Jan 3.
We hypothesized that women undergoing scoliosis surgery who became pregnant would go to full term, have uncomplicated pregnancies, and similar patient-reported outcome measures than non-pregnant patients and healthy controls.
Two hundred five women with adolescent idiopathic scoliosis (AIS) undergoing scoliosis surgery between 1998 and 2015 at several institutions in 1 country and 173 healthy women, without AIS, parous and nulliparous, were selected at random.
One hundred eight women with scoliosis surgery and no pregnancy (SNP), 97 women with scoliosis surgery and pregnancy (SP), 91 healthy controls and no pregnancy, and 82 healthy controls and pregnancy (HP) were reviewed. Mean follow-up was 5 years in the SNP, 6 years in the SP, 5 years in the healthy controls and no pregnancy, and 5 years in the HP. The average time from surgery to childbirth was 5 years. Back pain (BP) during pregnancy was observed in 48% of the SP and 34% of the HP. BP after childbirth was present in 43% of the SP and 42% of the HP. Patients fused to L3 or L4 experienced more frequent low BP during pregnancy (40%) than those fused above L3 (P < 0.05). Cesarean section (CS) was performed for 64% and 33% in SP and HP, respectively (P < 0.05). As the lowest instrumented vertebra moved caudal to L4, the frequency of CS increased (P < 0.05; R = 0.8). The majority of CS in SP were performed in patients fused to L4 (55%) versus patients fused above and to L3 (45%) (P < 0.05). The most common analgesia for CS was spinal block (75% in SP and 86% in HP). Patients fused to L4 required general anesthesia significantly more often (7%) versus those fused above L4 (4%, P < 0.05). The health-related quality of life after spinal fusion showed general satisfaction and were similar for SNP and SP (mean 3.84 and 3.91, respectively). No sexual dysfunction was reported.
Women with a history of spinal fusion for AIS fused to L3 or L4 reported a higher incidence of low BP, and CSs are more frequently required. This risk increased to 55% when spinal fusion to L4 was performed. The quality of life and sexual function were at the same level in women after scoliosis surgery than in healthy controls.
我们假设接受脊柱侧弯手术的女性怀孕后能够足月分娩，妊娠过程无并发症，且患者报告的结局指标与未怀孕患者及健康对照相似。
从1个国家的多个机构中随机选取了205例1998年至2015年间接受脊柱侧弯手术的青少年特发性脊柱侧弯（AIS）女性患者以及173例无AIS的健康已育和未育女性。
对108例接受脊柱侧弯手术且未怀孕（SNP）的女性、97例接受脊柱侧弯手术且怀孕（SP）的女性、91例健康且未怀孕的对照以及82例健康且怀孕（HP）的对照进行了回顾。SNP组的平均随访时间为5年，SP组为6年，健康未怀孕对照组为5年，HP组为5年。从手术到分娩的平均时间为5年。SP组48%的女性和HP组34%的女性在孕期出现背痛（BP）。产后BP在SP组为43%，在HP组为42%。融合至L3或L4的患者孕期低血压发生率（40%）高于融合至L3以上的患者（P<0.05）。SP组和HP组剖宫产（CS）率分别为64%和33%（P<0.05）。随着最低固定椎向尾侧移至L4以下，CS发生率增加（P<0.05；R=0.8）。SP组大多数CS手术在融合至L4的患者中进行（55%），而融合至L3及以上的患者为45%（P<0.05）。CS最常用的镇痛方法是脊髓阻滞（SP组为75%，HP组为86%）。融合至L4的患者比融合至L4以上的患者更常需要全身麻醉（分别为7%和4%，P<0.05）。脊柱融合术后与健康相关的生活质量总体满意度较高，SNP组和SP组相似（分别为3.84和3.91）。未报告性功能障碍。
有AIS脊柱融合病史且融合至L3或L4的女性低血压发生率较高，且更常需要剖宫产。当融合至L4时，这种风险增加到55%。脊柱侧弯手术后女性的生活质量和性功能与健康对照处于同一水平。
