Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA.
Department of Cardiology, Boston Children's Hospital, Boston, MA.
Spine (Phila Pa 1976). 2021 Jul 15;46(14):E791-E796. doi: 10.1097/BRS.0000000000003905.
Case series.
In this study we focus on this group, and describe the largest cohort to date of single ventricle patients undergoing surgical correction of scoliosis at a single institution.
Outcomes of spinal surgery for patients with congenital heart disease (CHD) have evolved and most affected patients have uncomplicated procedures. The risk of perioperative complications remains highest in patients with single ventricle ("Fontan") physiology.
We reviewed patients with single ventricle CHD and operative scoliosis repair over a 25-year span. Patients who had undergone a Fontan, bidirectional Glenn, and/or Kawashima procedure before operative scoliosis repair were included. Patients were excluded if they lacked preoperative cardiac care and/or sufficient medical history at our institution.
Twenty-three patients were included. The average age at surgery was 13.6 years (range, 5-23). Seventy percent of the cohort was female (16/23). The majority of patients underwent a Fontan before scoliosis surgery (20/23, 87%). Patients without intraoperative tranexamic acid (TXA) had a 67% complication rate (8/12) versus 36% (4/11) in those with intraoperative TXA (P = 0.29). There was a significant difference in estimated blood loss by weight (cc/kg) between non-TXA and TXA patients (P = 0.016). Twelve patients experienced complications (52%), all of which occurred postoperatively. There were no deaths, cerebrovascular events, adverse perioperative cardiac or hemodynamic complications, or wound infections. Using the Clavien-Dindo-Sink classification for postoperative complications, four patients had serious adverse events, including one permanent neurologic deficit.
Spinal surgery for scoliosis has been performed in selected patients with single ventricle physiology at a single institution without mortality for 25 years. Operative blood loss may be reduced by routine use of TXA. Complications occur most commonly in the postoperative period, and can include pleural effusion.Level of Evidence: 4.
病例系列。
本研究重点关注这一组患者，并描述迄今为止在单一机构接受单心室患者脊柱侧弯手术的最大队列。
患有先天性心脏病（CHD）的患者脊柱手术的结果已经发展，大多数受影响的患者都接受了简单的手术。在单心室（“Fontan”）生理学患者中，围手术期并发症的风险仍然最高。
我们回顾了 25 年来患有单心室 CHD 和手术性脊柱侧弯修复的患者。在进行手术性脊柱侧弯修复之前接受过 Fontan、双向 Glenn 和/或 Kawashima 手术的患者包括在内。如果患者在我们的机构中缺乏术前心脏护理和/或足够的病史，则将患者排除在外。
共纳入 23 例患者。手术时的平均年龄为 13.6 岁（范围，5-23）。70%的患者为女性（16/23）。大多数患者在脊柱侧弯手术前接受了 Fontan（20/23，87%）。术中未使用氨甲环酸（TXA）的患者并发症发生率为 67%（8/12），而术中使用 TXA 的患者为 36%（4/11）（P=0.29）。非 TXA 组和 TXA 组患者的估计失血量（cc/kg）存在显著差异（P=0.016）。12 例患者发生并发症（52%），均发生在术后。无死亡、脑血管事件、围手术期心脏或血液动力学不良并发症或伤口感染。根据术后并发症的 Clavien-Dindo-Sink 分类，4 例患者发生严重不良事件，包括 1 例永久性神经功能缺损。
25 年来，在单一机构中，对单心室生理患者进行脊柱侧弯手术没有死亡。常规使用 TXA 可减少手术失血量。并发症最常发生在术后期间，可能包括胸腔积液。
4 级
