Du Jerry Y, Poe-Kochert Connie, Thompson George H, Son-Hing Jochen P, Hardesty Christina K, Mistovich R Justin
Division of Pediatric Orthopedics, Rainbow Babies and Children's Hospitals/ University Hospitals Cleveland Medical Center; Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
Department of Orthopedic Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
Spine Deform. 2020 Oct;8(5):939-949. doi: 10.1007/s43390-020-00128-y. Epub 2020 May 12.
Retrospective case-series study of prospectively collected data.
We sought to identify the differences in outcomes between one-stage (single surgical episode) and two-stage (separate day) anterior and posterior spinal fusion and segmental spinal instrumentation surgeries in severe non-idiopathic and idiopathic scoliosis cases.
Patients with severe pediatric spine deformity may require combined anterior and posterior fusion procedures. Given their increased complexity and morbidity, surgeons may consider staging these procedures on separate days.
A retrospective cohort study was performed on a prospective Pediatric Spine Database. Patients 21 years of age or under with pediatric scoliosis who underwent primary anterior and posterior spinal deformity correction surgery either through a one-stage or planned two-stage sequence with greater than 2-year follow-up were included. Differences in demographics, comorbidities, surgical details, perioperative morbidity, complications, and outcomes were assessed based on scoliosis etiology. Multivariate models were utilized to control for confounders.
There were 70 non-idiopathic (14 two-stage vs. 56 one-stage) and 65 idiopathic scoliosis (8 two-stage vs. 57 one-stage) patients. Mean follow-up was 90.1 ± 54.7 months. In non-idiopathic scoliosis patients, two-stage surgery was independently associated with a 140-min increased surgical time (95% confidence interval: 52-229 min, p = 0.002) and an 8.2-day (95% confidence interval: 2.3-14.1 days, p = 0.007) increased hospital length of stay. In idiopathic scoliosis patients, two-stage surgery was independently associated with a 2108 ml increase in crystalloid use (95% confidence interval: 834-3381 ml p = 0.002) and a 5.3-day increased hospital length of stay (95% confidence interval: 4.0-6.5 days, p < 0.001). There were no significant differences in blood loss, transfusions, complications, or post-operative curves on multivariate analysis between one-stage and two-stage surgery cohorts in either non-idiopathic or idiopathic scoliosis patient groups.
Two-stage surgery was associated with increased crystalloid use in idiopathic scoliosis patients and longer operative times in non-idiopathic scoliosis patients, and longer hospital length of stay in both populations, without significant difference in complications or deformity correction. In the appropriate patient, one-stage anterior-posterior scoliosis surgery may be preferable to two-stage surgery.
Level III Retrospective Comparative Study.
对前瞻性收集的数据进行回顾性病例系列研究。
我们试图确定在严重非特发性和特发性脊柱侧弯病例中，一期（单次手术）和二期（分日进行）前路和后路脊柱融合及节段性脊柱内固定手术的预后差异。
患有严重小儿脊柱畸形的患者可能需要联合前路和后路融合手术。鉴于手术复杂性和发病率增加，外科医生可能会考虑在不同日期分期进行这些手术。
对前瞻性小儿脊柱数据库进行回顾性队列研究。纳入年龄在21岁及以下、患有小儿脊柱侧弯且接受过一期或计划二期的前路和后路脊柱畸形矫正手术且随访时间超过2年的患者。根据脊柱侧弯病因评估人口统计学、合并症、手术细节、围手术期发病率、并发症及预后的差异。采用多变量模型控制混杂因素。
有70例非特发性脊柱侧弯患者（14例二期手术 vs. 56例一期手术）和65例特发性脊柱侧弯患者（8例二期手术 vs. 57例一期手术）。平均随访时间为90.1±54.7个月。在非特发性脊柱侧弯患者中，二期手术独立相关于手术时间增加140分钟（95%置信区间：52 - 229分钟，p = 0.002）和住院时间增加8.2天（95%置信区间：2.3 - 14.1天，p = 0.007）。在特发性脊柱侧弯患者中，二期手术独立相关于晶体液使用量增加2108毫升（95%置信区间：834 - 3381毫升，p = 0.002）和住院时间增加5.3天（95%置信区间：4.0 - 6.5天，p < 0.001）。在非特发性或特发性脊柱侧弯患者组中，一期和二期手术队列在多变量分析中的失血量、输血情况、并发症或术后侧弯方面无显著差异。
二期手术与特发性脊柱侧弯患者晶体液使用量增加、非特发性脊柱侧弯患者手术时间延长以及两组患者住院时间延长相关，在并发症或畸形矫正方面无显著差异。对于合适的患者，一期前后路脊柱侧弯手术可能优于二期手术。
III级回顾性比较研究。
