Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China.
Institute of Spinal Deformity, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, P. R. China.
Ann Vasc Surg. 2021 Oct;76:514-535. doi: 10.1016/j.avsg.2021.03.032. Epub 2021 Apr 24.
Superior mesenteric artery (SMA) syndrome is a well-recognized, rare complication of undergoing surgical correction of a spinal deformity. The objective of this study was to summarize the best available evidence on SMA syndrome treatment after scoliosis surgery. To identify differences, special attention was paid to scoliosis pathology, intervention and SMA syndrome presentation.
A systematic review of the literature was performed on SMA syndrome following scoliosis surgery. The Web of Science, PubMed, Wanfang (Chinese) and EMBASE databases were systematically searched for articles from January 1971 to October 2020. The main subjects discussed are scoliosis pathology, intervention and SMA syndrome presentation.
A total of 32 articles with 52 cases were included in our report. The mean age of patients with SMA syndrome following scoliosis surgery was 14.7 ± 2.9 years and the majority (n = 42, 80.8%) were girls. The most frequently reported scoliosis type was adolescent idiopathic scoliosis (n = 34, 65.4%). The mean postoperative days (POD) (interval between the surgical treatment and the onset of symptoms) was 9.6 ± 9.5 days. Different treatment methods were analyzed in 46 patients. We noted a trend toward a higher percentage of patients with POD < 48 hr in the group with surgical treatment than in the conservative treatment group (P = 0.002).
In summary, in this systematic review, for the first time, we found that the time of onset of postoperative symptoms can be used as an important reference index for surgical intervention. We also believe that recommendations about the treatment of SMA syndrome following scoliosis surgery should include this finding. Given the lack of robust clinical evidence, these findings warrant verification in a prospective multicenter screening trial.
肠系膜上动脉（SMA）综合征是脊柱畸形矫正术后一种公认的罕见并发症。本研究旨在总结脊柱侧凸术后 SMA 综合征治疗的最佳证据。为了识别差异，特别关注了脊柱侧凸病理、干预措施和 SMA 综合征表现。
对脊柱侧凸术后 SMA 综合征的文献进行了系统回顾。通过 Web of Science、PubMed、万方（中文）和 EMBASE 数据库，系统地检索了 1971 年 1 月至 2020 年 10 月的文章。主要讨论的主题是脊柱侧凸病理、干预措施和 SMA 综合征表现。
共纳入 32 篇文章，其中 52 例患者。脊柱侧凸术后 SMA 综合征患者的平均年龄为 14.7±2.9 岁，其中大多数（n=42，80.8%）为女性。最常报道的脊柱侧凸类型是青少年特发性脊柱侧凸（n=34，65.4%）。术后天数（POD）（手术治疗与症状出现之间的间隔）的平均值为 9.6±9.5 天。46 例患者分析了不同的治疗方法。我们注意到，在接受手术治疗的患者中，POD<48 小时的患者比例高于保守治疗组（P=0.002）。
综上所述，在本系统评价中，我们首次发现术后症状出现的时间可以作为手术干预的重要参考指标。我们还认为，关于脊柱侧凸术后 SMA 综合征治疗的建议应包括这一发现。鉴于缺乏强有力的临床证据，这些发现需要在一项前瞻性多中心筛查试验中进行验证。
