Children's Hospital of Orange County, Orange, USA.
Riverside University Health System, 26520 Cactus Ave. B2042, Moreno Valley, CA, 92555, USA.
Eur Spine J. 2021 Mar;30(3):733-739. doi: 10.1007/s00586-020-06715-x. Epub 2021 Jan 18.
The purpose of this study was to evaluate differences in pain, opiate utilization and oxygen (O) consumption during the immediate post-operative course for patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) with and without thoracoplasty.
Patients aged 10-21 years old that had undergone PSF for AIS were identified from 1/1/16-8/1/18. A cohort of patients that did not have a thoracoplasty group was used as a control group. A standardized pain protocol (rapid response pathway) was implemented on all patients. A retrospective chart review was performed. Pre-operative, operative and post-operative data and SRS scores were analyzed.
Forty-six patients (38 girls, 8 boys) were included, 23 in each group. The average age was 15.2 years (range 12.0-19.3) and BMI was 20.9 (range 13.1-37.6). Differences in visual analog scores, post-operative oxygen and narcotic consumption were not statistically significant on any POD. Total opiate utilization was 146.06 morphine milligram equivalents (MME) in the control group and 149.41 MME in the thoracoplasty group (p = 0.78). One-year SRS self-image scores were higher in the thoracoplasty group (4.24 vs 3.96) (p = 0.007). There was no difference in length of hospitalization (3.6 vs 3.5 days), levels fused (12.9 vs 12.9) or blood loss (334.1 vs 413.5 mL). There was one pleural effusion and no instances of intercostal neuralgia or pneumothorax in the thoracoplasty group.
There is no increase in immediate post-operative pain, narcotic use or oxygen consumption when a thoracoplasty is performed with a PSF for AIS. Improved SRS self-image scores were seen after thoracoplasty.
本研究旨在评估行后路脊柱融合术（PSF）治疗青少年特发性脊柱侧凸（AIS）患者中，行与不行胸廓成形术的患者在术后即刻的疼痛、阿片类药物使用和耗氧量方面的差异。
从 2016 年 1 月 1 日至 2018 年 8 月 1 日，我们确定了行 PSF 治疗 AIS 的年龄在 10-21 岁的患者。未行胸廓成形术的患者为对照组。所有患者均采用标准化疼痛方案（快速反应途径）。进行了回顾性图表审查。分析了术前、术中和术后数据以及 SRS 评分。
46 例患者（38 名女性，8 名男性）入组，每组 23 例。平均年龄为 15.2 岁（范围 12.0-19.3），BMI 为 20.9（范围 13.1-37.6）。在任何术后日，视觉模拟评分、术后氧和阿片类药物消耗的差异均无统计学意义。对照组的总阿片类药物用量为 146.06 吗啡毫克当量（MME），胸廓成形术组为 149.41 MME（p=0.78）。胸廓成形术组的 1 年 SRS 自我形象评分较高（4.24 分比 3.96 分）（p=0.007）。住院时间（3.6 天比 3.5 天）、融合节段数（12.9 节比 12.9 节）和失血量（334.1 毫升比 413.5 毫升）无差异。胸廓成形术组有 1 例胸腔积液，无肋间神经痛或气胸。
在 AIS 的 PSF 中进行胸廓成形术时，术后即刻疼痛、阿片类药物使用或耗氧量不会增加。胸廓成形术后 SRS 自我形象评分得到改善。
