2014年日本脊柱侧弯学会发病率与死亡率调查：2012年至2014年脊柱畸形手术的并发症趋势
The Japanese Scoliosis Society Morbidity and Mortality Survey in 2014: The Complication Trends of Spinal Deformity Surgery from 2012 to 2014.
作者信息
Sugawara Ryo, Takeshita Katsushi, Inomata Yasushi, Arai Yasuhisa, Takaso Masashi, Takahashi Jun, Hosoe Hideo, Itou Manabu
机构信息
Department of Orthopedic Surgery, Jichi Medical University, Tochigi, Japan.
Morbidity, Mortality and Outcome Committee of Japanese Scoliosis Society, Chiba, Japan.
出版信息
Spine Surg Relat Res. 2018 Dec 1;3(3):214-221. doi: 10.22603/ssrr.2018-0067. eCollection 2019.
INTRODUCTION
The Japanese Scoliosis Society (JSS) created a longitudinal complication survey of spinal deformity surgery and established the Morbidity and Mortality (M&M) Committee in 2012. The purpose of this study was to analyze the results of the complication survey in 2014 and to report the differences in the complication rates between the years 2012 and 2014.
METHODS
A request to participate in this survey was mailed to all JSS members. The questionnaires were sent through e-mail to the members who took part in this survey, and the responses were returned through the same. Diagnosis was grouped into idiopathic scoliosis, congenital scoliosis, neuromuscular scoliosis, spondylolisthesis, pediatric kyphosis and adult spinal deformity. Complication was grouped into death, blindness, neurological deficit (motor or sensory deficit), infection, massive bleeding, hematoma, pneumonia, cardiac failure, DVT/PE, gastrointestinal perforation and instrumentation failure.
RESULTS
A total of 2,012 patients were reported from 71 institutes. Overall, complications were observed in 326 patients, and the complication rate increased from 10.4% in 2012 to 15.3% in 2014. The complication rate decreased from 8.8% to 3.7% in idiopathic scoliosis, 21.9% to 15.8% in neuromuscular scoliosis and 26.8% to 0% in kyphosis. The complication rate increased from 6.6% to 14.4% in congenital scoliosis, 9.3% to 12.0% in other types of scoliosis, 3.5% to 14.3% in spondylolisthesis and 21.6% to 26.0% in adult spinal deformity. The rate of neurological deficit, especially in motor deficit, increased from 3.2% to 7.7% in older patients with adult spinal deformity. Instrumentation failure was also more common in patients with adult spinal deformity (5.2% to 5.8%), especially in patients aged 40-65 years (4.4% to 9.1%).
CONCLUSIONS
The major complication trends were an increasing rate of neurological deficit and instrumentation failure, especially in adult spinal deformity.
引言
日本脊柱侧弯学会（JSS）开展了一项脊柱畸形手术纵向并发症调查，并于2012年成立了发病率与死亡率（M&M）委员会。本研究的目的是分析2014年并发症调查的结果，并报告2012年和2014年并发症发生率的差异。
方法
向所有JSS成员邮寄了参与本调查的请求。问卷通过电子邮件发送给参与本调查的成员，并通过相同方式回收回复。诊断分为特发性脊柱侧弯、先天性脊柱侧弯、神经肌肉型脊柱侧弯、腰椎滑脱、小儿脊柱后凸和成人脊柱畸形。并发症分为死亡、失明、神经功能缺损（运动或感觉缺损）、感染、大出血、血肿、肺炎、心力衰竭、深静脉血栓形成/肺栓塞、胃肠道穿孔和内固定失败。
结果
71家机构共报告了2012例患者。总体而言，326例患者出现并发症，并发症发生率从2012年的10.4%升至2014年的15.3%。特发性脊柱侧弯的并发症发生率从8.8%降至3.7%，神经肌肉型脊柱侧弯从21.9%降至15.8%，脊柱后凸从26.8%降至0%。先天性脊柱侧弯的并发症发生率从6.6%升至14.4%，其他类型脊柱侧弯从9.3%升至12.0%，腰椎滑脱从3.5%升至14.3%，成人脊柱畸形从21.6%升至26.0%。老年成人脊柱畸形患者的神经功能缺损发生率，尤其是运动功能缺损发生率，从3.2%升至7.7%。内固定失败在成人脊柱畸形患者中也更常见（5.2%至5.8%），尤其是40 - 65岁的患者（4.4%至9.1%）。
结论
主要并发症趋势是神经功能缺损和内固定失败发生率上升，尤其是在成人脊柱畸形中。
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