Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, 100730, China.
Key Laboratory of Big Data for Spinal Deformities, Chinese Academy of Medical Sciences, Beijing, 100730, China.
BMC Musculoskelet Disord. 2021 May 25;22(1):483. doi: 10.1186/s12891-021-04361-y.
Adult non-degenerative scoliosis accounts for 90% of spinal deformities in young adults. However, perioperative complications and related risk factors of long posterior instrumentation and fusion for the treatment of adult non-degenerative scoliosis have not been adequately studied.
We evaluated clinical and radiographical results from 146 patients with adult non-degenerative scoliosis who underwent long posterior instrumentation and fusion. Preoperative clinical data, intraoperative variables, and perioperative radiographic parameters were collected to analyze the risk factors for perioperative complications. Potential and independent risk factors for perioperative complications were evaluated by univariate analysis and logistic regression analysis.
One hundred forty-six adult non-degenerative scoliosis patients were included in our study. There were 23 perioperative complications for 21 (14.4%) patients, eight of which were cardiopulmonary complications, two of which were infection, six of which were neurological complications, three of which were gastrointestinal complications, and four of which were incision-related complication. The independent risk factors for development of total perioperative complications included change in Cobb angle (odds ratio [OR] = 1.085, 95% CI = 1.035 ~ 1.137, P = 0.001) and spinal osteotomy (OR = 3.565, 95% CI = 1.039 ~ 12.236, P = 0.043). The independent risk factor for minor perioperative complications is change in Cobb angle (OR = 1.092, 95% CI = 1.023 ~ 1.165, P = 0.008). The independent risk factors for major perioperative complications are spinal osteotomy (OR = 4.475, 95% CI = 1.960 ~ 20.861, P = 0.036) and change in Cobb angle (OR = 1.106, 95% CI = 1.035 ~ 1.182, P = 0.003).
Our study indicate that change in Cobb angle and spinal osteotomy are independent risk factors for total perioperative complications after long-segment posterior instrumentation and fusion in adult non-degenerative scoliosis patients. Change in Cobb angle is an independent risk factor for minor perioperative complications. Change in Cobb angle and spinal osteotomy are independent risk factors for major perioperative complications.
成人非退行性脊柱侧凸占年轻成人脊柱畸形的 90%。然而，长节段后路内固定融合治疗成人非退行性脊柱侧凸的围手术期并发症及其相关危险因素尚未得到充分研究。
我们评估了 146 例成人非退行性脊柱侧凸患者接受长节段后路内固定融合治疗的临床和影像学结果。收集了术前临床资料、术中变量和围手术期影像学参数，以分析围手术期并发症的危险因素。通过单因素分析和 logistic 回归分析评估潜在的和独立的围手术期并发症危险因素。
本研究纳入了 146 例成人非退行性脊柱侧凸患者。21 例（14.4%）患者发生了 23 例围手术期并发症，其中 8 例为心肺并发症，2 例为感染，6 例为神经并发症，3 例为胃肠道并发症，4 例为切口相关并发症。总围手术期并发症的独立危险因素包括 Cobb 角的变化（比值比[OR] = 1.085，95%置信区间[CI] = 1.0351.137，P = 0.001）和脊柱截骨（OR = 3.565，95% CI = 1.03912.236，P = 0.043）。轻度围手术期并发症的独立危险因素是 Cobb 角的变化（OR = 1.092，95% CI = 1.0231.165，P = 0.008）。重度围手术期并发症的独立危险因素是脊柱截骨（OR = 4.475，95% CI = 1.96020.861，P = 0.036）和 Cobb 角的变化（OR = 1.106，95% CI = 1.035~1.182，P = 0.003）。
我们的研究表明，在成人非退行性脊柱侧凸患者中，Cobb 角的变化和脊柱截骨是长节段后路内固定融合术后总围手术期并发症的独立危险因素。Cobb 角的变化是轻度围手术期并发症的独立危险因素。Cobb 角的变化和脊柱截骨是重度围手术期并发症的独立危险因素。
