Weissmann Karen Andrea, Lafage Virginie, Pitaque Carlos Barrios, Lafage Renaud, Huaiquilaf Carlos M, Ang Bryan, Schulz Ronald G
Escuela de Doctorado, Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
Departamento de Ortopedia y Traumatología, Universidad de Chile, Santiago, Chile.
Asian Spine J. 2021 Dec;15(6):778-790. doi: 10.31616/asj.2020.0263. Epub 2020 Dec 28.
Single-center, retrospective cohort study conducted from 2013 to 2017.
To determine the risk factors for surgical complications in neuromuscular scoliosis based on known patient comorbidities.
The concept of neuromuscular scoliosis includes a wide variety of pathologies affecting the neuromuscular system. Complications are numerous and are often difficult to predict.
A retrospective analysis of a single-center database was conducted from 2013 to 2017. Inclusion criteria were patients aged <25 years, diagnosis of neuromuscular scoliosis, and history of posterior fusion deformity surgery. A total of 64 patients (mean age, 15 years; 63% females) were included in this study. Clinical, radiological, and laboratory parameters in the preoperative, intraoperative, and postoperative settings were analyzed. Univariate analysis was performed using Student t-test for continuous variables, and a chi-square test was used for noncontinuous variables. Multivariate analysis was performed to identify predictors of major, mechanical, and total complications.
Complications were found in 44% of patients, with 46.9% consisting of major complications, and 84.4% being early complications. Univariate analysis revealed that the presence of perinatal comorbidities, independent of other comorbidities, increased the risk for complications (p=0.029). Preoperative hypoglycemia, high number of instrumented levels, longer surgical time, use of an all-screw construct, lower preoperative pelvic obliquity, postoperative lower kyphosis, high thoracic spinopelvic angle (as measured by T9 spino-pelvic inclination), absence of deep drain, and use of superficial drain were associated with postoperative complications (all p<0.05). Logistic regression demonstrated that comorbidities, longer surgical time, hypoglycemia, and absence of deep drains are predictors of complications. Independent variables that predicted major complications were the number of levels fused, postoperative kyphosis (p=0.025; odds ratio [OR], 1.074), and high screw density (p=0.014; OR, 4.380).
Complications in neuromuscular scoliosis are increased by comorbidities, long surgical time, and inadequate correction. Preventative measures to decrease these complications include appropriate preoperative patient preparation and surgical planning.
2013年至2017年进行的单中心回顾性队列研究。
基于已知的患者合并症确定神经肌肉型脊柱侧弯手术并发症的危险因素。
神经肌肉型脊柱侧弯的概念包括影响神经肌肉系统的多种病理情况。并发症众多且往往难以预测。
对2013年至2017年的单中心数据库进行回顾性分析。纳入标准为年龄<25岁、诊断为神经肌肉型脊柱侧弯且有后路融合畸形手术史的患者。本研究共纳入64例患者（平均年龄15岁；63%为女性）。分析术前、术中和术后的临床、放射学和实验室参数。连续变量采用Student t检验进行单因素分析，非连续变量采用卡方检验。进行多因素分析以确定主要、机械性和总体并发症的预测因素。
44%的患者出现并发症，其中46.9%为主要并发症，84.4%为早期并发症。单因素分析显示，围产期合并症的存在，独立于其他合并症，增加了并发症风险（p = 0.029）。术前低血糖、内固定节段数量多、手术时间长、使用全螺钉结构、术前骨盆倾斜度低、术后后凸畸形低、高胸段脊柱骨盆角（通过T9脊柱骨盆倾斜度测量）、未放置深部引流管以及使用浅表引流管与术后并发症相关（所有p<0.05）。逻辑回归显示合并症、手术时间长、低血糖和未放置深部引流管是并发症的预测因素。预测主要并发症的独立变量为融合节段数量、术后后凸畸形（p = 0.025；比值比[OR]，1.074）和高螺钉密度（p = 0.014；OR，4.380）。
合并症、手术时间长和矫正不足会增加神经肌肉型脊柱侧弯的并发症。减少这些并发症的预防措施包括适当的术前患者准备和手术规划。
