3 岁前植入肋骨牵开器与更高的非计划性重返手术室率相关。

Rib-based Distraction Device Implantation Before Age 3 Associated With Higher Unplanned Rate of Return to the Operating Room.

机构信息

Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.

出版信息

J Pediatr Orthop. 2021 Jul 1;41(6):e369-e373. doi: 10.1097/BPO.0000000000001823.

DOI:10.1097/BPO.0000000000001823

PMID:33782371

Abstract

BACKGROUND

Surgical treatment of early-onset scoliosis (EOS) with rib-based implants such as the vertical expandable prosthetic titanium rib (VEPTR) is associated with a high rate of complications including surgical site infection, skin breakdown, and implant migration. Many of these complications warrant the need for unplanned reoperations, increasing the burden on an already vulnerable patient population, and introducing the further risk of infection. To provide insight into the risks of early intervention, we investigate the relationship between initial device implantation before the age of 3 and the rate of unplanned reoperation.

METHODS

A retrospective review was performed of all patients at a single institution who had undergone VEPTR insertion for EOS with at least a 2-year follow-up from 2007 to 2016. Patients were stratified into the case-cohort (0 to 2 y of age) or the comparison cohort (3 to 10 y of age) based on age at the time of device implantation. Multivariate regression accounting for age and scoliosis etiology was performed to identify factors predictive of unplanned reoperation.

RESULTS

A total of 137 of 185 patients treated with VEPTR were identified with 76 (56%) undergoing at least 1 unplanned reoperation during the study time period. There were 68 and 69 patients in the age 0- to 2-year and 3- to 10-year cohorts, respectively. Patients aged 0 to 2 years underwent a higher number of total procedures compared with those aged 3 to 10 (13.1±6.5 vs. 10.6±4.8, P=0.032). A significant difference was found in the rate of unplanned reoperation between the 2 cohorts with 44 (65%) patients aged 0 to 2 and 32 (46%) patients aged 3 to 10 undergoing at least 1 unplanned reoperation (P=0.031). Binary logistic multivariate regression accounting for age and scoliosis etiology demonstrated that patients aged 0 to 2 had a significantly greater odds of undergoing an unplanned reoperation (odds ratio=3.050; 95% confidence interval: 1.285-7.241; P=0.011) compared with patients aged 3 to 10 years.

CONCLUSION

Overall, EOS patients aged 0 to 2 at initial VEPTR implantation are up to 3 times higher risk of undergoing an unplanned reoperation compared with those aged 3 to 10.

LEVEL OF EVIDENCE

Level III.

摘要

背景

使用基于肋骨的植入物（如垂直可扩张假体钛肋骨[VEPTR]）对早发性脊柱侧凸（EOS）进行手术治疗，会导致高并发症发生率，包括手术部位感染、皮肤破裂和植入物迁移。许多这些并发症需要进行计划外的再次手术，这增加了已经脆弱的患者群体的负担，并带来了进一步感染的风险。为了深入了解早期干预的风险，我们研究了初始设备植入年龄在 3 岁以下与计划外再次手术率之间的关系。

方法

对 2007 年至 2016 年间在一家单机构接受 VEPTR 插入治疗的 EOS 患者进行了回顾性分析，这些患者的随访时间至少为 2 年。根据设备植入时的年龄，患者分为病例队列（0 至 2 岁）或对照组（3 至 10 岁）。进行了多变量回归分析，以确定与计划外再次手术相关的预测因素，该回归分析考虑了年龄和脊柱侧凸病因。

结果

共确定了 185 例接受 VEPTR 治疗的患者中的 137 例，在研究期间，76 例（56%）患者至少进行了 1 次计划外再次手术。年龄 0 至 2 岁组和 3 至 10 岁组分别有 68 例和 69 例患者。与 3 至 10 岁组相比，0 至 2 岁组的患者接受的总手术次数更多（13.1±6.5 次比 10.6±4.8 次，P=0.032）。2 个队列之间的计划外再次手术率存在显著差异，44 例（65%）0 至 2 岁组患者和 32 例（46%）3 至 10 岁组患者至少进行了 1 次计划外再次手术（P=0.031）。多变量二元逻辑回归分析考虑了年龄和脊柱侧凸病因，结果表明，与 3 至 10 岁组患者相比，0 至 2 岁组患者计划外再次手术的可能性显著更高（优势比=3.050；95%置信区间：1.285-7.241；P=0.011）。