Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, No. 8 Gongti South Rd, Beijing, 100043, China.
Department of Orthopedics, Beijing Haidian Hospital, Haidian section of Peking University Third Hospital, No. 29 Zhongguancun St, Beijing, 100080, China.
BMC Musculoskelet Disord. 2019 Jul 16;20(1):331. doi: 10.1186/s12891-019-2708-8.
Although surgery prevents the progression of deformity and maintains the overall balance of the spine in congenital scoliosis (CS) patients, it is associated with a high risk of perioperative complications. Pulmonary complication is one of the most common complications. This retrospective study aimed to investigate the risk factors for pulmonary complications in CS patients after posterior spinal instrumentation and fusion.
Analysis of consecutive patients who underwent posterior spinal instrumentation and fusion for congenital scoliosis was performed. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for pulmonary complications. Patients were separated into groups with and without postoperative pulmonary complications. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of pulmonary complications.
Three hundred and twenty-three CS patients were included. Forty-five (13.9%) patients developed postoperative pulmonary complications, which included pleural effusion in 34 (75.6%) cases, pneumonia in 24 (53.3%) cases, pneumothorax in 3 (6.7%) cases, atelectasis in 4 (8.9%) cases, pulmonary edema in 2 (4.4%) cases, respiratory failure in 2 (4.4%) cases, and prolonged mechanical ventilation in 4 (8.9%) cases. The independent risk factors for development of pulmonary complications included age (Odds ratio (OR) = 1.088, P = 0.038), reoperation (OR = 5.150, P = 0.012), preoperative pulmonary disease (OR = 10.504, P = 0.004), correction rate (OR = 1.088, P = 0.001), middle thoracic screw-setting (OR = 12.690, P = 0.043), and thoracoplasty (OR = 5.802, P = 0.001). The area under the receiver operating characteristic (ROC) curve based on predicted probability of the logistic regression was 0.903.
Age, reoperation, preoperative pulmonary disease, correction rate, middle thoracic screw-setting, and thoracoplasty were independent risk factors for pulmonary complications after posterior spinal instrumentation and fusion in CS patients.
尽管手术可以防止先天性脊柱侧凸（CS）患者的畸形进展并维持脊柱的整体平衡，但它与围手术期并发症的高风险相关。肺部并发症是最常见的并发症之一。本回顾性研究旨在探讨后路脊柱器械固定融合术后 CS 患者肺部并发症的危险因素。
对接受后路脊柱器械固定融合术治疗先天性脊柱侧凸的连续患者进行分析。收集术前临床资料、术中变量和围手术期影像学参数，分析术后肺部并发症的危险因素。将患者分为术后发生肺部并发症组和未发生肺部并发症组。单因素检验识别潜在危险因素。多因素 logistic 回归用于评估肺部并发症的独立预测因素。
共纳入 323 例 CS 患者。45 例（13.9%）患者术后发生肺部并发症，其中胸腔积液 34 例（75.6%），肺炎 24 例（53.3%），气胸 3 例（6.7%），肺不张 4 例（8.9%），肺水肿 2 例（4.4%），呼吸衰竭 2 例（4.4%），机械通气时间延长 4 例（8.9%）。发生肺部并发症的独立危险因素包括年龄（优势比（OR）=1.088，P=0.038）、翻修手术（OR=5.150，P=0.012）、术前肺部疾病（OR=10.504，P=0.004）、矫正率（OR=1.088，P=0.001）、中胸段螺钉固定（OR=12.690，P=0.043）和胸廓成形术（OR=5.802，P=0.001）。基于逻辑回归预测概率的受试者工作特征（ROC）曲线下面积为 0.903。
年龄、翻修手术、术前肺部疾病、矫正率、中胸段螺钉固定和胸廓成形术是 CS 患者后路脊柱器械固定融合术后肺部并发症的独立危险因素。
