Matsumoto Hiroko, Kawakami Noriaki, Saito Toshiyuki, Uno Koki, Suzuki Teppei, Watanabe Kota, Matsumoto Morio, Yamaguchi Toru, Yanagida Haruhisa, Kotani Toshiaki, Demura Satoru, Takeshita Katsushi, Taniguchi Yuki
Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, 3959 Broadway, Suite 800 North, New York, NY, 10032, USA.
Department of Orthopaedic and Spine Surgery, Meijyo Hospital, Sannomaru, 1-3-1, Naka-ku, Nagoya, Aichi, 460-0001, Japan.
Spine Deform. 2020 Aug;8(4):733-742. doi: 10.1007/s43390-020-00082-9. Epub 2020 Feb 27.
This was a multi-center retrospective cohort study included consecutive pediatric patients who were admitted to 8 institutions for the treatment of congenital spinal deformity from 1991 to 2012.
The purpose of this study was to compare curve corrections and balances, reoperations, and complications at 2-year follow-up between those treated early vs. late. Although early intervention has been recommended, no empirical study has examined the optimal timing of short fusion among patients with congenital spinal deformity.
Patients with congenital spinal deformity with formation failure undergoing vertebrectomy with short fusion (≤ 6 fusion segments) were categorized as early (surgery at ≤ 6 years) and late (7-18 years) fusion. Outcomes included coronal and sagittal curve corrections at immediate and 2-year evaluations; loss of curve correction from immediate to 2-year follow-up; coronal and sagittal balance at 2 years; and inter-operative, major and minor short-term postoperative, and long-term postoperative complications and reoperations.
Early fusion (N = 79) compared to late fusion (N = 96) was associated with greater percent curve correction at immediate (71% vs. 60%, p = 0.0046) and 2-year (63% vs. 52%, p = 0.0153) evaluations adjusting for surgeon experience and preoperative coronal balance. These associations were significant for males and those with 3-level fusions but not 4 to 6-level fusions. Early fusion compared with late fusion had more intraoperative (6% vs. 1%) and postoperative long-term complications (27% vs. 18%), as well as unplanned reoperations (13% vs. 9%). Early vs. late fusion had fewer short-term complications, both major (6% vs. 15%) and minor (6% vs. 15%).
Patients who underwent early treatment achieved larger major curve correction by 10% compared to patients with late treatment when assessed at 2-year postoperative evaluation. However, early fusion should be considered with careful attention to possible increased risk of reoperations.
Level III.
这是一项多中心回顾性队列研究，纳入了1991年至2012年期间连续入住8家机构接受先天性脊柱畸形治疗的儿科患者。
本研究的目的是比较早期治疗与晚期治疗患者在2年随访时的侧弯矫正和平衡情况、再次手术情况及并发症。尽管推荐早期干预，但尚无实证研究探讨先天性脊柱畸形患者短节段融合的最佳时机。
对因形成障碍而接受椎体切除并短节段融合（≤6个融合节段）的先天性脊柱畸形患者，分为早期融合组（手术年龄≤6岁）和晚期融合组（7 - 18岁）。结局指标包括即刻及2年评估时的冠状面和矢状面侧弯矫正情况；从即刻到2年随访期间侧弯矫正的丢失情况；2年时的冠状面和矢状面平衡情况；以及术中、术后短期主要和次要并发症、长期并发症及再次手术情况。
在调整外科医生经验和术前冠状面平衡后，早期融合组（N = 79）与晚期融合组（N = 96）相比，在即刻评估时（71% 对 60%，p = 0.0046）和2年评估时（63% 对 52%，p = 0.0153）的侧弯矫正百分比更高。这些关联在男性和3节段融合患者中显著，但在4至6节段融合患者中不显著。早期融合与晚期融合相比，术中并发症更多（6% 对 1%）、术后长期并发症更多（27% 对 18%）以及计划外再次手术更多（13% 对 9%）。早期融合与晚期融合相比，短期并发症更少，包括主要并发症（6% 对 15%）和次要并发症（6% 对 15%）。
在术后2年评估时，与晚期治疗的患者相比，早期治疗的患者主要侧弯矫正幅度大出10%。然而，考虑早期融合时应谨慎关注再次手术风险可能增加的情况。
三级。
